Upcoming changes: EVV compliance guidelines and deadlines

The 21st Century Cures Act requires states to implement electronic visit verification (EVV) for all Medicaid home health and personal care services. The EVV program for the Ohio Department of Medicaid (ODM) leverages technology to capture essential data for claims adjudication. Specific requirements can be found in Chapter 5160—32 — Ohio Administrative Code | Ohio Laws. Provider types and specialties subject to EVV requirements should ensure compliance with EVV guidelines.

We validate claims requiring EVV against data collected in Sandata when adjudicating claims. If a claim is not accepted, please review data collected by Sandata and update claim information where appropriate; we ask that you ensure claim data is accurate before resubmitting.

Discrepancies are currently paid with notifications on the Explanation of Benefits (EOB); however, this will change as follows:

• Beginning June 1, 2025: Claims with the following codes will not be paid if there are discrepancies:
• G0156 — Home Health Aide
• G0151 — Home Health Physical Therapies
• G0152 — Home Health Occupational Therapies
• G0153 — Home Health Speech Language Pathology Therapies
• G0299 — Home Health Nursing RN
• G0300 — Home Health Nursing LPN
• Beginning August 1, 2025: Claims with the following codes will not be paid if there are discrepancies:
• T1000 — RN & LPN Private Duty Nursing
• T1001 — Registered Nurse Assessment
• T1001 with U9 Modifier — Registered Nurse Consultation

Unique provider types	Provider type description	Unique provider specialty	Provider specialty description
16	16 – Other Accredited Home Health Agency	160	160 – Other Accredited Home Health Agency
25	25 – Non‑Agency Personal Care Aide	161	161 – ODM Otherwise Accredited Home Health Agency
26	26 – Non‑Agency Home Care Attendant	250	250 – ODM Waiver Non‑Agency Personal Care Attendant
38	38 – Non‑Agency Nurse – RN or LPN	260	260 – ODM Waiver Non‑Agency Home Care Attendant
45	45 – Waivered Services Organization	380	380 – RN Private Duty Nursing
50	50 – Clinic	381	381 – PDN/ODM Waiver Registered Nurse
55	55 – Waivered Services Individual	382	382 – LPN – Private Duty Nursing
60	60 – Medicare Certified Home Health Agency	383	383 – PDN/ODM Waiver Licensed Practical Nurse
65	65 – Clinical Nurse Specialist Individual	480	480 – ODA Waiver
71	71 – Nurse midwife Individual	490	490 – DODD Waiver
72	72 – Nurse Practitioner Individual	492	492 – DD Waiver and Nursing
76	76 – Durable Medical Equipment Supplier	600	600 – Medicare Certified Home Health Agency
83	83 – Wheelchair Van	601	601 – ODM Medicare Certified Home Health Agency
89	89 – Non‑State Operated ICF‑MR
96	96 – Behavioral health paraprofessional

More information is available on the ODM’s website under Electronic Visit Verification.

EVV Informational sessions:

• March 31, 2025, at 10 a.m. ET
• April 16, 2025, at 1 p.m. ET

To register, go to EVV Webinar. For additional inquiries, email ohmedicaidencpesupport@anthem.com.