In This Issue:
As we wrap up 2025, we want to thank you for your dedication in meeting the EVV claims matching requirements introduced earlier this year. Your efforts in adapting to these changes have been essential to ensuring compliance with federal standards, and we truly appreciate your commitment. Through your hard work, we are seeing steady increases in claims matching with providers in phases 1-5 averaging around a 90% claims matching rate.
Thank you for your dedication to providing quality care to Ohioans served by Medicaid. Your efforts are clear, measurable, and highly commendable!
This week Ohio Medicaid launched the Next Generation MyCare Program, introducing a person-centered, integrated approach to supporting Ohioans eligible for both Medicaid and Medicare health coverage. With the January 1 launch please note:
- Anthem has been added as a new MyCare Ohio program payer in the EVV system.
- Aetna no longer participates in any Medicaid program requiring electronic visit verification. If creating an authorization or visit effective January 1 or later Aetna will not be an available selection.
- United Healthcare (UHC) is not participating in the new MyCare Ohio program. However, it will continue supporting EVV requirements for Medicaid managed enrollees using home health and private duty nursing services and will remain as a payer in the EVV system.
Additionally, the Ohio Department of Medicaid (ODM) proactively updated approved Live-In Caregiver exemptions as a courtesy to reduce administrative burden to providers. This allows the approved exemptions to remain in effect and transition to newly selected MyCare health plans for individuals newly enrolled or switching to a Next Generation MyCare health plan. You can view all approved live-in caregivers by following these instructions.
For more guidance on this transition please see Next Gen MyCare Plan Changes Affecting EVV.
Effective January 1, Ohio Home Care Waiver (OHCW) and PASSPORT waiver providers are required to submit claims with complete and matching EVV data. Claims that do not match will be denied.
To help meet new data requirements, OHCW and PASSPORT providers are encouraged to take advantage of resources tailored specifically for you. You can find them on Medicaid’s Electronic Visit Verification webpage. And, if you need a refresher on claims validation trainings, HHA Exchange has made a series of pre-recorded OHCW and PASSPORT Phase 6 learning sessions available to you on demand.
Zendesk, the Sandata EVV help desk solution, is introducing new safeguards to better secure member Protected Health Information (PHI) in its customer support transactions.
Beginning February 1, Zendesk automated email notifications will include only the most recent comments or responses to a help desk ticket. Individual attachments and full ticket histories will no longer be included in these emails, adding an additional layer of defense against unwarranted or accidental data exposure.
The new security feature affects automated email notifications only. Providers can continue to access complete ticket details and histories by logging directly into the Zendesk portal.
|
Effective April 1, any visit with a date of service on or after 4/1/2026 that is submitted from an alternate EVV vendor to the Sandata Aggregator must include Edit Reason Code “99” for manually edited visits.
Visits submitted with any other Edit Reason Code will be rejected by Sandata.
Action Required
Get a jump start on the upcoming requirement by entering “99” as the Edit Reason Code on all manually edited visits submitted by your alternate EVV vendor.
Ohio Medicaid hosts the EVV Stakeholder Workgroup meeting on Monday, January 26. Please feel free to join us by registering here.
To catch up on our latest discussion see the December 16 Stakeholder Workgroup presentation.
Sandata regularly updates its EVV software via releases to ensure everything runs smoothly. Below are the changes you may have noticed in the Sandata system last month:
|
Date
|
System
|
Issue
|
Description
|
|
12/17/2025
|
Registration Portal
|
Provider Registration Enhancement
|
When a provider uses a less common email domain, like “@provider.health” instead of .com or .org, the portal could not provide a confirmation email. The registration portal has been updated to allow less common email domains so that registrations can be completed.
|
|
12/17/2025
|
EVV
|
Unit Calculation Update (DODD Overnight Visits)
|
DODD Visits that were automatically split during the daylight savings time (DST) switch in November were undercounting units on the post-midnight portion of the visit. The unit calculation for this scenario has now been updated to accommodate DST.
|
Questions about releases or the system in general should be directed to the Sandata EVV Provider Hotline at 855-805-3505 or ODMCustomerCareemail@sandata.com.
Ohio Medicaid and HHA Exchange (formerly Sandata Technologies) are ready to assist providers and agencies in meeting claims validation requirements and more.
Click here to see who to contact regarding specific topics.
|
