EVV Compliance Change Effective January 1, 2025

Providers must achieve an 85% Electronic Visit Verification (EVV) compliance rate.

Highmark Wholecare is reminding providers of an important change to EVV compliance requirements for Personal Care Services (PCS) and Home Health Care Services (HHCS), effective January 1, 2025. The Pennsylvania Department of Human Services (DHS) now requires a minimum 85% compliance rate for verified visits without manual edits. This means 85% of submitted visits must be complete and accurate, requiring no manual correction or data entry after the visit. This is a mandatory change to adhere to both federal and state regulatory (21st Century Cures Act) requirements.

How to Prepare

To prepare for this increased compliance rate, providers should proactively take the following steps:

1.) Review Internal EVV Procedures:

• Ensure that all staff are properly trained and consistently follow correct EVV data entry protocols.
• Reinforce these protocols through regular reminders and training sessions to achieve the 85% threshold in 2025.
• Refer to state guidance issued by DHS (MA Bulletin 05-20-03, MA Bulletin 07-20-04, and MA Bulletin 05-22-09) for previously established EVV manual edit thresholds.

2.) Utilize the DHS EVV Compliance Report: As of January 1, providers should monitor compliance using the report within the Sandata EVV Aggregator. Access the report by completing these steps:

• Log into the Sandata Aggregator.
• Select "Reports" from the left-hand menu.
• Choose "Date Range Reports" from the "Report Type" dropdown.
• Select "EVV Compliance" from the "Report Name" dropdown.
• Click "Run Report."
• Providers can filter by date, account, client, or employee as needed.

Highmark Wholecare will notify providers who have not met the overall compliance rate of 85%. Failure to repeatedly maintain an 85% or higher EVV compliance rate may result in a Corrective Action Plan (CAP) or other disciplinary action. Further details will be shared in upcoming communications.

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