In This Issue:
The Phase 1 Roll Out Impacts Home Health Services Fee-for-Service Claims Billed to Ohio Medicaid.
Over the past several months, the Ohio Department of Medicaid has been working with Sandata, ODM’s Electronic Visit Verification vendor, to prepare providers for changes coming to the EVV claims adjudication process. As ODM previously announced, to make this transition as smooth as possible for providers, the department will stagger the roll out of claims validation by phases.
The first phase will apply to home health services fee-for-service claims billed to ODM and consists of the following service codes:
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Service Code
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Service
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G0156
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Home health aide
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G0151
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Home health physical therapies
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G0152
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Home health occupational therapies
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G0153
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Home health speech language pathology therapies
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G0299
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Home health nursing registered nurse (RN)
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G0300
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Home health nursing licensed practical nurse (LPN)
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For details, please review the full December 5 email notice shared with EVV providers. For a list of services subject to EVV, please review the ODM EVV Program and Service Code Guide.
With Phase One of the electronic visit verification claims processing changes fast approaching, the Ohio Department of Medicaid is announcing dates of the following six phases of the claims adjudication process.
The first phase, which includes home health services claims billed to ODM, will officially go into effect on March 1. At the time of this change, claims that require electronic visit verification must have a matching EVV visit record. Claims that do not match will be denied.
Other providers will be phased in beginning on June 1, with full implementation expected by the end of the first quarter of 2026. Services and execution dates are listed in the chart below.
 ODM is working with Sandata, our EVV vendor, to make sure you are ready for this change. Office hours are available daily on Zoom for 1:1 assistance.
Look for more communication about training sessions and resources from ODM as the phases progress.
Ohio Medicaid is committed to ensuring your success in meeting new claims validation requirements that will go live in phases beginning March 1 and continuing through the early 2026.
In addition to taking a measured approach in implementing these changes, ODM and Sandata have provided a series of resources and learning opportunities to prepare you – all of which can be found on Medicaid's EVV webpage. They include:
- Dedicating daily support desk office hours specifically to help providers prepare for the implementation.
- Enhancing online system guides to clarify how to view and update claims data to ensure 100% accuracy.
- Launching the EVV Provider Look-Up Dashboard enabling providers to clearly view incidents in which data discrepancies may delay a claims payment.
- Publishing an EVV Claims Validation Process Flowchart which details each step in the claims validation process.
- Creating a Claims Validation Components infograph that highlights key elements needed to successfully submit a claim.
- Distributing a EVV Claims Preparedness Checklist that calls out important actions providers should take to strengthen compliance.
Throughout February ODM and Sandata will have teams available to assist the Phase 1 home health services providers meet the March 1 claims requirements. With each upcoming phase we will share lessons learned to help you smoothly transition to this new process.
On March 1, EVV providers offering home health services to Medicaid recipients are required to meet specific criteria when submitting claims to be reimbursed timely.
As we get closer to the launch date, here are the top actions providers can take to strengthen compliance with Medicaid’s claims adjudication process:
- Before submitting a claim, verify that the visit exists in the EVV system.
- Confirm that claims submitted are for visits that are in a “Verified” status.
- Address any exception regarding a visit prior to submitting a claim. Claims should be clear of notes, exclusions, or omissions.
- Verify that the units on a claim are equal to or less than what was logged in EVV system.
- Review and validate 100% data accuracy in the following areas:
- Service(s) captured.
- Payer service(s) are aligned.
- Recipient and Recipient Medicaid ID are correct.
- The visit is logged in the correct EVV account with the correct provider Medicaid ID and correct date range on the Payer section for the appropriate service(s).
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If you are using an Alternate EVV provider, your vendor may not be sending modifiers with the service codes on visits.
Please check the Sandata EVV Aggregator and review your visits to ensure any service code that should have a modifier added was sent over to the Aggregator correctly.
NOTE: There are only two services that have a variation with and without a modifier: G0493/G0493 U9 and T1001/T1001 U9.
Sandata is offering dedicated office hours daily to provide support with electronic visit verifications as we move closer to claims validation. Providers can attend to get help with visit maintenance, data entry, getting started, general program inquiries, and more.
Phase 1 providers who bill for home health fee for service to ODM are strongly encouraged to take advantage of this help ahead of March 1. These office hours will continue to be offered for each phased implementation ahead.
Please click here to register for a session.
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Ohio Medicaid recently updated its EVV webpage resources to offer providers and vendors clearer guidance on the Sandata EVV system.
Under the “Provider News” section, web visitors can now view:
 Medicaid’s EVV Provider Look-Up Dashboard has been updated to include data on claim lines submitted in state fiscal year 2025 (July 2024 forward) with paid dates after October 16, 2024.
With the enhancement, a new dashboard view allows Phase 1 providers to see the number of paid claim lines and dollar amounts associated with specific EVV errors (procedure code does not match, etc.). The view also allows visitors to see specific errors by service code.
HELPFUL HINT: When on the dashboard, links placed on the right side of the page access claims data submitted after October 16, 2024. The link on the left side of the dashboard page allows users to access data submitted prior to July 1, 2024.
If you are a Phase 1 provider with claims paid after October 16, 2024, please access the dashboard and view your EVV claims performance. For more details about these updates refer to the January 15 Provider Dashboard Update.
For assistance navigating the dashboard, review the provider lookup quick reference guide.
 Electronic Visit Verification System Enhancements Training
Description: This two-hour course will guide agencies and independent providers through enhancements made to the EVV system.
Intended Audience: Agency administrative staff and independent providers using the Sandata system. This training is not intended for agency-employed direct care workers or participant-directed only providers who receive payment through a financial management service.
Aggregator Training
Description: This one-hour course will guide agency providers using an alternate vendor through the recently implemented changes to reporting and sign-in.
Intended Audience: Agency provider administrative staff using an alternate vendor.
Optional Scheduling Training
Description: Scheduling is an optional feature in the Sandata EVV system. This one-hour course will show users how to create and manage schedules for direct care workers. Using this feature reduces the need for direct care workers to enter the client or recipient ID for each participant and allows them to see their schedule directly in the Sandata Mobile Connect application.
Intended Audience: Agency administrative staff and independent providers who use the Sandata EVV system to capture visits.
NOTE: Trainings are not intended for agency-employed direct care workers or participant-directed only providers who receive payment through a financial management service.
Visit Sandata Learn to check out training resources available to you.
Sandata regularly updates its EVV software via releases to ensure it runs smoothly. Below are the changes introduced in the Sandata EVV web portal and Sandata Mobile Connect app in January.
 Sandata Release Notes are available but require a Zendesk EVV account to view.
Questions about releases or the system should be directed to the Sandata EVV Provider Hotline at 855-805-3505 or ODMCustomerCareemail@sandata.com.
To stay updated on ODM EVV program communications, sign up for notifications by clicking Subscribe to Medicaid News on the Ohio Medicaid website.
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