2026 EVV Compliance Enforcement for Home Health Providers

As previously communicated in Highmark Wholecare’s November 2025 Newsletter and in alignment with the DHS bulletin, we want to ensure all providers are prepared for the upcoming 2026 EVV compliance enforcement changes.

As a Physical HealthChoices Managed Care Organization (MCO), Highmark Wholecare is monitoring your agency's EVV compliance. Providers who exceed the 15% manual edit threshold, and therefore fall below 85% compliance, will receive a formal letter of non-compliance. This letter will require your agency to complete a Corrective Action Plan (CAP) to articulate the changes made to ensure ongoing compliance.

Please be aware that continued non-compliance may lead to further action or sanctions, including overpayment notifications or termination from the Highmark Wholecare network.

We strongly encourage your team to take proactive steps to monitor and ensure your agency meets these compliance requirements. HHAeXchange provides several options to monitor and leverage the data effectively.

HHAeXchange generates comprehensive monthly compliance reports. These reports are sent to providers on the 21st of each month and provide a summary of your agency’s EVV compliance with in-scope contracts and services billed to each MCO.

These reports outline visit data for the previous month with both month and year-to-date snapshots. All numbers can be validated through your agency’s HHAeXchange exception reports and are also visible for each respective payer.

These reports are automatically emailed to each user with an ADMIN role in your HHAeXchange portal. Please review your agency’s HHAeXchange user roles to ensure the appropriate personnel are receiving these critical updates.

Not Receiving Monthly Report? If your agency is not currently receiving these monthly reports, please open a new support ticket with the HHAeXchange support team for assistance. 

Directions to use the HHAeXchange Reporting Module (see HHAeXchange webinar Boost Your EVV Compliance):

• Navigate to the Report module > EVV Compliance Reports
• Select the desired report
• Input any filters
• Select View Report

We are here to support providers in achieving and maintaining compliance. For any questions or concerns regarding EVV, please do not hesitate to contact Highmark Wholecare’s EVV Team at EVV@highmark.com.