North Carolina Medicaid: State upholds EVV transmission requirements

Use HHAeXchange for data transmission and crosswalk for appropriate code information

As a home health care provider for Standard Plans and Tailored Plans in North Carolina, you’re required by the state to complete 2 submissions when billing for an encounter visit:

• Transmit EVV data documenting services provided to the member
• Submit claim information for reimbursement of services provided

Before submitting the information, please verify the following:

• The EVV service codes transmitted to HHAeXchange must exactly match what you submitted to UnitedHealthcare for the prior authorization approval and claim
• The taxonomy code entered on the claim must appropriately match the home health services you’re authorized to perform. If you’re not billing under taxonomy code 251E00000X, the claim will be denied.

How to transmit EVV data

You can comply with state regulations by using 1 of the following methods to transmit data:  

• 1-step integrated billing
  • You or a third-party vendor transmits EVV and claim data directly to HHAeXchange 
  • HHAeXchange sends the data to UnitedHealthcare for claim processing
• 2-step direct billing
  • You submit claims to UnitedHealthcare through an EDI clearinghouse 
    • We’ll pend the claim for 14 days to allow for the EVV transmission to HHAeXchange
  • The EDI vendor transmits the EVV data to HHAeXchange

 Submitting the claim directly to UnitedHealthcare can help give you more visibility into the claim status.  

What you need to do

Follow due process for EVV requirements and proper claims processing:

• Confirm your vendor successfully imported the visit date into HHAeXchange
• Work with your vendor to monitor and resolve visit import failures
• Check UnitedHealthcare claim status to validate HHAeXchange exported the EVV data
• Regularly review and resolve prebilling and billing holds

Avoid claim denials

To help ensure timely reimbursement:

• Use the appropriate service type, revenue code and HCPC/CPT® code listed on the UnitedHealthcare Community Plan of North Carolina home health electronic visit verification crosswalk
• Verify the EVV service and revenue codes match the claim information

Questions? We’re here to help.

Connect with us through chat 24/7 in the UnitedHealthcare Provider Portal. For questions about EVV system integration, open a ticket with HHAeXchange support or email ncevv@uhc.com.