On April 1, 2026, MO HealthNet stopped paying any Missouri Medicaid visit that is not properly registered in Sandata. The state's Electronic Visit Verification program has been live since November 2023, but each year the bar gets higher, and the four-month grace period that ran from January through March 2026 is now over. In the first weeks of April we have seen visits accepted by Sandata, then quietly marked incomplete, then denied at billing, for reasons agencies could not see on their own. This article walks through what is actually causing those denials, what to do about each one, and how Ankota's EVV software prevents most of them at submission so you do not learn about them at the end of the month.
Starting April 1, 2026, MO HealthNet will not pay any Missouri Medicaid visit that is not properly registered in Sandata, the state's EVV aggregator. The Missouri EVV program has been in place since November 2023, but the state raises the bar every year. The four months from January through March 2026 were communicated as a grace period for agencies and EVV vendors to confirm that every visit was flowing through to Sandata correctly. As of April 1, that grace period closed, and Ankota customers, like every Missouri Medicaid provider, are now living under the new rule: if Sandata does not have a clean, complete record of the visit, the visit does not pay.
This change matters more than the previous Missouri EVV updates because it removes the safety net agencies relied on. Until now, a visit could be flagged inside Sandata as incomplete and still pay if the billing claim was clean. Now MO HealthNet pulls the source of truth from Sandata, and a Sandata problem is a payment problem.
To be accepted by Sandata, a Missouri Medicaid visit needs to be submitted with the BillVisit parameter set to true, ideally as an EVV-compliant visit, and if it is not EVV-compliant, with an appropriate reason code, an approval, and (for some reason codes) a note. Those are the basic mechanics. In the Ankota EVV system, every one of those fields is handled in the workflow your scheduler or biller is already using, so the right reason code, approval source, and note are captured before the visit ever leaves your office.
Agencies that work with third-party EVV vendors do not need to memorize the full Sandata specification, but everyone in the office should know the difference between EVV-compliant (caregiver clocked in and out on time using a valid EVV method) and not-EVV-compliant (anything else, which requires a reason code). The most common reason codes in Missouri include forgotten clock-outs, technology failures, and manual entries, and each has its own approval and note requirements.
Your EVV software should tell you whether each visit was accepted, rejected, or held by Sandata. In the Ankota EVV system, that status is visible on every visit, so a scheduler or biller can see at a glance which visits are clean and which need attention. If your current EVV system does not surface Sandata's response, you will have to log into the Sandata portal yourself and look for visits that were not accepted, which is a slow and error-prone way to find problems at the end of a billing cycle.
There is one situation no EVV vendor can fully prevent on its own: a visit Sandata accepts during the submission handshake, but then quietly marks as incomplete inside the Sandata system. Sandata does not push that "incomplete" status back to third-party EVV software, so your vendor cannot tell you in real time. The next section covers what to do about it.
Sandata sometimes accepts a visit at the submission API and then marks it incomplete inside the Sandata portal for reasons that are not returned to your EVV software. The most common cause we have seen since the start of April is missing task codes on visit types that require them. Personal care, homemaker, and chore visits all require task codes drawn from the authorization (delivered today through Fusion, formerly through CyberAccess) and matched to Sandata's task code specification. If the codes are not on the visit, Sandata will accept the visit at the handshake and then silently mark it incomplete.
Ankota now blocks this at submission: if the visit type requires task codes and they are missing, the visit cannot be sent to Sandata until the codes are added. If the visit type does not allow task codes (respite, for example), Ankota strips them so none are sent. This is the kind of guardrail we wish every Missouri EVV vendor had in place by April 1, 2026.
We've found the best practice for solving these issues is to provision a Sandata login for your EVV vendor's team. That way they can log in, find the cases that slipped through, and update their software so the same situation never happens again to you or to any of their other customers.
In an audit, if MO HealthNet compares the prescribed care plan from Fusion to the tasks your caregivers actually completed, and the right tasks were not documented, the agency can be required to pay back the time those tasks represent. The penalty is quantified in units of care. If the Fusion plan says a caregiver should spend 15 minutes on cleaning the kitchen one time per week, and the audit shows that task was not completed, the agency is liable for that one unit. Multiply that across a participant panel and a year of visits and the exposure becomes meaningful.
This is why the most common EVV shortcut, which we describe in the next section, is a quiet audit risk even when it gets your visit submitted.
The most common Missouri EVV error we see is a forgotten clock-out, and the fix is not to game the reason code. We have watched agencies on a very popular EVV product use reason code 160 (caregiver forgot to clock out), set the visit end time to the expected end, then click four or five task codes that "everybody gets" and submit. That gets the visit accepted by Sandata, but most participants have between 11 and 16 tasks on their care plan, and four or five generic clicks will not hold up in an audit. The Ankota approach is to prevent the missed clock-out in the first place rather than paper over it.
Caregivers forget to clock out for three main reasons. The first is consumer-directed services (CDS) where the attendant lives in the home and provides far more hours of care than the program reimburses, so there is no natural forcing function. The second is a flat-out forgotten clock-out, which is rare for agency-directed in-home visits but still common in CDS for the same living-situation reason. The third is the use of two different EVV methods to clock in and out (telephony in, mobile out, for example), which we cover in its own section below.
On the advice of one of my favorite agency owners, Miss Beverly B, we have a method of reducing missed clock-outs to almost zero. If you'd like to learn how we do this, please set up a call with Kirstin: https://meetings.hubspot.com/kirstin-speaks.
When a caregiver works past the authorized time and you want to bill only the authorized units, you now have to correct the visit time in your EVV software to match the remaining authorization before submitting to Sandata. Until April 1, 2026, an over-worked visit was fine: Sandata captured the clocked time, your biller submitted the lower billable time to MO HealthNet, and everything reconciled because the visit existed in both systems. That arrangement is no longer working. MO HealthNet now pulls the visit time from Sandata, not from your billing claim, and if the two disagree, the visit denies.
We have already seen end-of-month situations where a participant ran out of units, the agency billed the remaining 16 units, but Sandata had 17 units recorded because the visit was over-worked by 15 minutes. The whole visit denied. Our current recommendation to Ankota customers is to correct the EVV time so the visit matches the remaining authorized time. That goes through as a manual verification (because the time was edited), but the clock-out was valid, just late, so the manual verification is defensible. In our editorial view, working a bit past the authorized time should not be an EVV question at all, but the rule is what it is, and agencies have to adapt.
Sandata has started rejecting Missouri visits when the caregiver clocked in with one EVV method and clocked out with another, even though both methods are individually compliant. We have seen this most often with voice telephony clock-ins paired with mobile app clock-outs, and the reverse. The same rule applies to Fixed Object Verification (FOB) devices: if a FOB is used at the start of the visit, a FOB needs to be used at the end. Ankota flags this mismatch before submission so the office can correct it rather than discover the rejection days later.
The fix is a combination of caregiver training and software guardrails. Pick a primary method for each caregiver and each participant, make sure backup methods are documented, and use an EVV system that warns you when the two clock events do not match. This is one of the failure modes that did not exist before April 2026, so even experienced Missouri agencies are getting tripped up by it.
To fix a visit Sandata marked incomplete, your EVV vendor needs to omit the original visit and resubmit the corrected visit with a different visit ID. "Omit" is a slight misnomer: the original visit is not removed from Sandata. Instead, the BillVisit flag is flipped to false, which keeps the history intact but tells Sandata to ignore that record for billing. Then the same visit is resubmitted with corrected data and a new visit ID so Sandata does not confuse it with the omitted version. In Ankota this is a workflow your team can run from the visit screen, with full history preserved.
In the first weeks of April, the most common reason we ran this fix for Ankota customers was missing task codes on visits that required them. We have since closed that gap permanently in our software, but if a new edge case appears, the omit-and-resubmit pattern is how it gets corrected.
Missouri agencies that support consumer-directed services through the Independent Living Waiver have to use all of the participant's CDS units (T1019 with the U2 modifier) before shifting to ILW units (T1019 with the U6 modifier) in a given month, and any mid-day split has to be reflected in both your billing and Sandata. Ankota handles the split automatically. Even when there is day-to-day variance in visit length, we know exactly when the last CDS unit is consumed, and behind the scenes we split that day's visit at the unit boundary, billing the first portion as T1019U2 and the second portion as T1019U6.
The problem we have seen at other agencies is that they are still guessing when CDS will run out, then submitting whole days to Sandata as CDS and trying to bill the back end as ILW. When that guess is wrong, the visits submitted to Sandata with U2 do not match the U6 billing claims, and the visits deny. The fix is the same omit-and-resubmit pattern: void the U2 visits in Sandata, resubmit the corrected portion under U6 with a new visit ID, and rebill.
When MO HealthNet says the denial is your EVV vendor's fault, ask your vendor for the specific Sandata error code and the rejection reason, and treat any "it's your vendor" answer from the state as a starting point, not the conclusion. In some cases the state is right, and in fact several agencies switched to Ankota in April because their previous EVV vendor literally was not getting them paid. But a meaningful share of April denials we have investigated for our own customers turned out to be participant spend-down events, authorization changes the state made without notifying the agency, or other claim-side issues that an EVV vendor cannot see or fix.
A good third-party EVV vendor will work the issue with you either way. Ankota's approach is to provide the specific error and the Sandata reason on every rejected visit, then collaborate with your billing team to determine whether the fix is on our side, your side, or the state's side. If your current vendor is not engaging that way, that is a signal worth acting on.
Ankota's mission for Missouri is to keep every payable visit payable. Since April 1, 2026, we have closed gaps as we have found them, and our team treats Missouri customers as partners: when you call us about a denial, we work it with you until it is paid, and then we update the software so the next agency does not hit the same wall. If you want to see how we prevent task code, clock-out, and authorization mismatches at the point of submission, take a look at our EVV software, our EVV pillar guide, and our companion article on the four Missouri EVV changes coming in 2026, or just contact Ankota and we will set up a working session with our Missouri team.
For background on Sandata's role in the broader Missouri Medicaid program, the state publishes its EVV provider resources through the Missouri Department of Social Services MO HealthNet EVV page, and the federal 21st Century Cures Act EVV requirements are documented on Medicaid.gov.
Sandata is the EVV aggregator MO HealthNet uses to receive and validate every Missouri Medicaid in-home visit. Since April 1, 2026, MO HealthNet pulls visit data directly from Sandata when adjudicating claims, so a visit that is not properly registered in Sandata does not get paid, regardless of what your billing claim says.
What is the BillVisit parameter and why is it important?BillVisit is a true/false flag that EVV vendors send with each visit to tell Sandata whether the visit is billable. Setting BillVisit to true is required for any visit you want paid. When you need to correct a visit that Sandata marked incomplete, the omit-and-resubmit process works by flipping BillVisit to false on the original visit and resubmitting the corrected visit with a new visit ID.
How do I prevent task code problems on personal care visits?Use an EVV software that blocks submission of personal care, homemaker, or chore visits without the required task codes drawn from the participant's Fusion authorization, and that strips task codes from visit types like respite that do not allow them. Ankota added both of these guardrails in April 2026 after seeing missing-task-code denials in the first weeks of the new MO HealthNet rule.
What happens if a caregiver works longer than the authorized time?Before April 1, 2026, over-worked visits reconciled at the billing claim level. Since then, MO HealthNet uses the Sandata time as the source of truth, so over-worked visits deny if the Sandata time exceeds the remaining authorization. The current best practice is to correct the visit time in your EVV software to match the remaining authorized time, which goes through as a manual verification but is defensible because the clock-out was valid.
Why are visits getting rejected when the caregiver used both telephony and the mobile app?Sandata has started rejecting Missouri visits when the clock-in method does not match the clock-out method, even though both telephony and mobile are individually EVV-compliant. The same rule applies to FOB devices. Use one method per visit, and pick an EVV system that warns you before submission when the two events do not match.
How do I correct a visit Sandata accepted but later marked incomplete?Have your EVV vendor omit the original visit (which flips BillVisit to false in Sandata while preserving history) and resubmit the corrected visit with a new visit ID. Ankota provides this workflow in the visit screen and recommends provisioning a Sandata login for your vendor's team so they can investigate root causes and prevent the same situation from recurring.
How does the CDS to ILW transition work without breaking Sandata?You have to use all the participant's CDS units (T1019 with the U2 modifier) before shifting to ILW units (T1019 with the U6 modifier) in a given month, and the split has to be reflected in both Sandata and your billing. Ankota splits the visit automatically at the exact unit boundary, even when day-to-day visit length varies, so the U2 and U6 portions match in both systems. Agencies that guess at the transition date and submit whole days as one code or the other end up running omit-and-resubmit fixes at month end.
What should I do if MO HealthNet tells me the denial is my EVV vendor's fault?Ask your vendor for the specific Sandata error code and rejection reason, then verify whether the issue is on the EVV side, the billing side, or the state side (spend-down events and authorization changes are common claim-side denials that look like EVV problems). A good third-party EVV vendor will work the issue with you either way; if yours will not engage, that is a signal worth acting on.
Ankota's mission is to enable the Heroes who keep older and disabled people living at home to focus on care because we take care of the tech. If you need software for home care, EVV, I/DD Services, Self-Direction FMS, Adult Day Care centers, or Caregiver Recruiting, please Contact Ankota. And if you're ready to see how the most innovative agencies are using AI to empower their caregivers and automate the rest, meet your new companion at www.kota.care.