Electronic Visit Verification (EVV) is now a hard billing requirement for Florida Medicaid personal care services. Agencies that submit claims without confirmed EVV data face systematic payment delays — not informal warnings. This guide covers what Florida requires, which systems comply, and exactly how EVV failures show up in your claims.
What Florida Medicaid Requires for EVV
Florida AHCA requires EVV for all Medicaid personal care services (PCS) and home health aide services. EVV must capture: type of service performed, individual providing the service, individual receiving the service, location of service delivery, date of service, and start and end time of service.
Florida uses Sandata as its EVV aggregator. Visit data from approved EVV systems (including HHAeXchange and Netsmart/Tellus) must transmit to Sandata before the claim is processed. AHCA has the ability to match claims against EVV records — claims without a matching EVV record are subject to recoupment.
Approved EVV Systems in Florida
- ✓HHAeXchange — the most widely used for Medicaid waiver and community care in Florida
- ✓Netsmart/Tellus — used primarily in the fee-for-service delivery system
- ✓Agency self-managed EVV — allowed for agencies with fewer than a specific visit threshold, subject to AHCA approval
- ✓Aggregator-open model — some MMC plans accept EVV data directly from the plan-approved system
How EVV Failures Show Up in Billing
- ✓Claim submitted before EVV data confirmed in Sandata — appears as a rejection from the payer with remark code indicating missing EVV
- ✓EVV visit time does not match the authorized service hours — flagged during claim adjudication
- ✓Caregiver in EVV record does not match the rendering provider on the claim
- ✓Visit location flagged as outside the patient's confirmed address — requires documentation of off-site care
- ✓EVV visit not associated with an active authorization — claim denied regardless of service being delivered
Florida MMC EVV requirements vary by plan. Sunshine Health, Humana Medicaid, Molina, and Simply Healthcare each have specific EVV submission requirements beyond Medicaid FFS. Confirm with each plan's provider manual before billing.
EVV Compliance Checklist for Florida Agencies
- ✓Confirm your EVV system is listed on AHCA's approved vendor list
- ✓Verify visit data is transmitting to Sandata — not just captured in your EVV system
- ✓Reconcile EVV records against scheduled visits weekly — gaps are denial triggers
- ✓Never submit a claim for a visit with an unresolved EVV exception
- ✓Train caregivers on clock-in/clock-out compliance — EVV data quality starts at the point of care
Leymax handles EVV-compliant billing for Florida home health agencies. We verify EVV data against Sandata before every claim submission.
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