2026 EVV Compliance Enforcement for Home Health Providers

Highmark Wholecare is committed to keeping providers informed about Electronic Visit Verification (EVV) compliance. The Pennsylvania Department of Human Services (DHS) recently released a Medical Assistance Bulletin regarding compliance enforcement of the 15% manual edit threshold.

According to the bulletin and Highmark Wholecare’s January 2025 Newsletter, beginning with dates of service on and after January 1, 2025, EVV providers must achieve an 85% verified visit compliance rate without manual edits. The manual entry percentage of visits should not exceed 15%.

As a Physical HealthChoices Managed Care Organization (MCO), Highmark Wholecare will be responsible for monitoring and notifying providers identified for non-compliance, beginning in 2026. Providers who exceed the 15% manual edit threshold and fall below 85% compliance for two consecutive quarters will be notified in a formal letter of non-compliance. This will require the provider to complete a Corrective Action Plan (CAP) within 30 days of the letter date.

Continued non-compliance may lead to further action or sanctions, such as overpayment notifications or termination from the network.

Actions to Take Now:

1. Reinforce Internal EVV Procedures: Ensure all staff are thoroughly trained on correct EVV data entry at the point of service to minimize manual edits.
2. Utilize EVV Compliance Reports Proactively: Monitor your manual entry percentage within HHAeXchange Compliance reports and the Sandata Aggregator (directions on how to access this platform can be found in the DHS bulletin) to make improvements proactively.

For any questions or concerns, please contact Highmark Wholecare's EVV Team at EVV@highmark.com.