Electronic Visit Verification (EVV) has become a critical component in ensuring accurate, compliant billing for Medicaid services across the United States. In North Carolina, the North Carolina EVV Aggregator plays a pivotal role in ensuring that Medicaid providers follow the necessary guidelines and maintain compliance with both state and federal mandates. This article aims to provide a thorough understanding of the North Carolina EVV Aggregator, its functions, and how Medicaid providers can effectively utilize it to avoid billing issues and ensure timely reimbursements.
I. Introduction
Electronic Visit Verification (EVV) systems have been a game-changer in ensuring the integrity of Medicaid services, especially for home health and personal care services. The North Carolina EVV Aggregator is a central system through which service data is captured, verified, and submitted for Medicaid claims. It acts as an intermediary between providers and the Medicaid system, ensuring that all required visit data is accurately recorded and compliant with both state and federal regulations.
The North Carolina EVV Aggregator is managed by Sandata Technologies, a company chosen by the state to provide EVV solutions for North Carolina Medicaid services. By using the aggregator, providers can ensure that claims are submitted with verified data, avoiding delays and denials in reimbursement.
II. What is the North Carolina EVV Aggregator?
The North Carolina EVV Aggregator is an integral component of the state’s effort to comply with the 21st Century Cures Act, a federal law mandating EVV systems for certain Medicaid-funded home and community-based services. The aggregator acts as a repository for all verified visit data and ensures that all services, including personal care and behavioral health services, are documented in accordance with the required EVV standards.
The North Carolina EVV Aggregator works in conjunction with third-party EVV vendors such as Sandata, HHAeXchange, and Carebridge. These vendors are responsible for capturing visit data using various technologies, such as mobile apps or biometric verification systems, which are then transmitted to the aggregator for verification and storage. The aggregator checks that the data is consistent and meets the necessary requirements before it is used to process Medicaid claims.
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III. The Role of EVV in North Carolina Medicaid
The introduction of EVV in North Carolina Medicaid services was a response to the federal 21st Century Cures Act, which mandates the use of EVV systems for personal care services (PCS) and home health care services. The North Carolina EVV Aggregator plays a central role in this process by collecting, verifying, and storing visit data to ensure that services are delivered as per the approved care plan.
For North Carolina, the EVV mandate applies to services provided under the Medicaid State Plan, including Personal Care Services (PCS) and Community Alternatives Programs (CAP). These services are crucial for individuals who need assistance with activities of daily living, such as bathing, dressing, and meal preparation. The North Carolina EVV Aggregator ensures that providers can capture and verify this visit data in real-time, preventing errors and fraud in billing.
By using the aggregator, providers can ensure that they meet all necessary documentation and verification requirements, preventing delays in Medicaid reimbursement. Furthermore, it helps the state reduce the risk of fraudulent claims, as every visit must be verified before a claim is submitted.
IV. How the North Carolina EVV System Works
The North Carolina EVV Aggregator is designed to work with various EVV vendors, allowing Medicaid providers to choose the solution that best fits their needs. These vendors provide different methods of capturing visit data, such as GPS-based tracking, biometric verification, or caregiver check-ins via mobile apps.
Once a visit is completed, the North Carolina EVV Aggregator collects the data from the vendor and verifies that it meets the state’s criteria for accuracy. This data includes information such as the date and time of the visit, the location of the service, and the caregiver’s identification. If the aggregator detects any discrepancies or missing information, it will flag the visit for further review before it can be used to process a Medicaid claim.
Providers are required to ensure that they are using a compliant EVV solution and are accurately submitting visit data to the North Carolina EVV Aggregator. Failure to do so can result in delayed payments, denials, or even penalties.
V. EVV Billing and Claims Process
One of the key aspects of the North Carolina EVV Aggregator is its role in ensuring that Medicaid claims are processed correctly. Once the EVV data has been verified, it is used to support the billing process. The North Carolina EVV Aggregator ensures that claims are submitted with the necessary visit verification data, which is essential for timely and accurate reimbursement.
For claims to be processed successfully, the visit data recorded in the EVV system must match the services provided as per the beneficiary’s care plan. This means that the number of units submitted must align with the verified visit data. If discrepancies arise, claims may be delayed or denied. Common issues related to EVV billing include Error Code 784, which occurs when no EVV data is present on the claim, or Edit Code 02077, which flags claims missing required EVV visit verification NC Medicaid Home.
To avoid these issues, providers must ensure that the data submitted to the North Carolina EVV Aggregator is accurate and complete. In the case of errors, the aggregator will pend the claim for a set period, during which providers can correct the discrepancies and resubmit the claim.
VI. Troubleshooting EVV Issues
Providers using the North Carolina EVV Aggregator may encounter billing or technical issues related to EVV data. These issues typically involve discrepancies between the visit data and the Medicaid claims submitted. Common errors include missing or incorrect information on the visit, such as incorrect service times or unverified units.
To troubleshoot these issues, providers should first check the North Carolina EVV Aggregator for any errors flagged during data verification. In many cases, errors are related to Edit Code 02077, which occurs when no EVV data is attached to the claim, or Edit Code 02079, which flags claims where the units submitted exceed the verified visit units
NC Medicaid Home. If providers are unable to resolve the issue, they should contact NCTracks for assistance.
Additionally, the North Carolina EVV Aggregator provides resources for providers to help them resolve issues, including troubleshooting guides and contact information for technical support. It is crucial for providers to stay up-to-date with system updates and requirements to avoid future billing issues.
VII. Registration and Compliance for Providers
In order to use the North Carolina EVV Aggregator, Medicaid providers must first complete a registration process. This involves submitting the necessary documentation and ensuring that the correct EVV vendor is being used. Providers with multiple National Provider Identifier (NPI) numbers must register each one separately with the North Carolina EVV Aggregator.
Once registered, providers are required to ensure compliance with all EVV requirements. This includes submitting verified visit data to the aggregator, adhering to the state’s billing codes, and following the state’s guidelines for reporting and data verification. Failure to comply with these requirements can lead to delayed or denied claims, which can affect a provider’s reimbursement rates.
To ensure compliance, providers should regularly review the latest Medicaid guidelines and the North Carolina EVV Aggregator‘s best practices to avoid errors in the billing process.
VIII. Future of EVV in North Carolina
As the North Carolina EVV Aggregator continues to evolve, the state’s requirements for EVV will likely expand to include additional services. For example, the mandate for EVV in Behavioral Health Services began in 2023, and similar expansions may occur in the future. As these changes are implemented, providers will need to stay informed about the latest developments and ensure that their EVV systems are compliant.
The role of the North Carolina EVV Aggregator will continue to grow as more services are integrated into the EVV system. Providers can expect to see more streamlined processes, as well as improvements in data verification and claims processing.
IX. Conclusion
The North Carolina EVV Aggregator plays a crucial role in ensuring the accuracy, compliance, and integrity of Medicaid services in the state. By capturing, verifying, and storing visit data, the aggregator helps providers submit accurate claims, reduce fraud, and avoid billing issues. To successfully navigate the EVV system, providers must stay compliant with state regulations, choose the right EVV vendor, and ensure that visit data is correctly submitted to the North Carolina EVV Aggregator.
By understanding the role and function of the North Carolina EVV Aggregator, providers can ensure smooth operations and timely reimbursements for Medicaid services. As EVV requirements evolve, staying informed and compliant will be essential for continued success in the Medicaid space.
