Home care North Carolina agency owners must act quickly. The NC Medicaid EVV hard launch on October 1, 2025 is approaching. From this date forward, all Home Health Care Services (HHCS) claims must include complete and validated North Carolina Electronic Visit Verification (EVV) data—or they will be denied.
This shift affects all home care agencies in NC providing Medicaid-funded HHCS, including home health aide, skilled nursing, and therapy services.
Bottom line: If your agency is not fully EVV-compliant by October 1, 2025, expect denied claims, lost revenue, and major administrative burdens.
During the soft launch (through September 30, 2025):
Starting October 1, 2025 (hard launch):
CareSmartz360 is an AI-powered, all-in-one home care software integrated with all North Carolina-approved aggregators. Further, the telephony & GPS-enabled mobile app solution assists Medicaid-enforcing agencies in meeting EVV requirements by state.
Missing EVV compliance isn’t just a paperwork issue. The stakes are high.
Failure to comply with EVV requirements by state is not just a paperwork issue. The risks are serious:
Without validated EVV, Medicaid claims will not be paid.
Agencies may struggle to pay caregivers or retain staff.
Non-compliance with the 21st Century Cures Act can trigger audits and increased oversight.
Misaligned schedules, untrained caregivers, and incorrect EVV vendor data can create operational chaos.
It’s not theoretical; many providers are already seeing rejections even during soft launch for mismatched or missing EVV data.
Here’s a step-by-step compliance checklist for any home care agency NC:
| Checklist Item | What to Check |
|---|---|
| Vendor Registration | Confirm your EVV vendor is approved by NC’s aggregators (HHAeXchange, CareBridge, or Sandata). |
| Code Crosswalk Alignment | Ensure correct service codes, revenue codes, and payer-program codes per North Carolina EVV requirements. |
| Billing Decisions | Decide whether you will direct bill or vendor-bill; communicate with your health plan. |
| Visit File Format | Check visit files meet state requirements: correct fields, payer IDs, date/time formats. |
| Staff Training | Train caregivers on clock-in/out, schedulers on authorization alignment, billing staff on rejection fixes. |
| Report Monitoring | Track rejections, “informational edits,” and claim denials; fix errors early. |
| Soft Launch Testing | Use September to run sample claims, test vendor integrations, and resolve mismatches. |
| Update Contact Info | Ensure your agency’s NPI, billing contacts, and aggregator details are accurate. |
| Feature | Soft Launch (through Sept 30, 2025) | Hard Launch (Oct 1, 2025 onwards) |
|---|---|---|
| Requirement to submit EVV data | Yes; “pay & report” model. Claims may be paid even if validation fails. | Yes; EVV data must be valid; claims without it will be denied. |
| Claims denial for missing EVV data | No; errors show as reports/edit flags. | Yes; claims missing required EVV pieces will be denied. |
| Time for agencies to test & fix vendor/format issues | Available; soft launch intended for configuration and testing. | Very limited margin; post-launch corrections more difficult and more costly. |
| Flexibility for mismatches in codes or different billing options | Some flexibility; reports allow corrections. | Very little to none; alignment must be correct beforehand. |
CareSmartz360 is an AI-powered, all-in-one home care software fully integrated with all North Carolina-approved aggregators (HHAeXchange, CareBridge, Sandata).
Book your CareSmartz360 demo now.
As a home care agency owner, your role is to make this hard launch not a crisis but an opportunity. You can become one of the agencies that’s known in your region for reliability, timely claims, clean documentation, and minimal denials. This transition is a chance for your agency to shine, attracting payers, clients, and caregivers.
Start communicating internally now—your caregivers, schedulers, billing staff all need to see what’s changing, why, and their part. This is a team effort, and everyone’s role is crucial in ensuring a smooth transition.
Build dashboards to track your EVV error rates and denials; make data visible. Use vendor and state support programs, and don’t assume your system is fully ready until you test it.
Because once October 1 hits, claims without matching EVV data won’t be paid. Your agency’s survival, reputation, and growth depend on making sure that doesn’t happen.
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