Running a Medicaid home care agency in Virginia got harder in the last year, and most of the new pain lands in the same place: getting paid. Humana's arrival under Cardinal Care changed how a whole group of visits has to be verified and billed, DMAS still requires documentation in its exact state formats, clients switch managed care plans without telling anyone, hospital stays quietly suspend waiver services, and personal care and respite have to be kept apart to the minute. None of these are new to us. Ankota already handles the HHAeXchange format, the DMAS forms, the mid-month payer switches, and the personal-care-to-respite split for agencies across Virginia and other states, so the five challenges below are the ones we spend our days solving.
Getting paid by Humana in Virginia is hard right now because Humana entered the Cardinal Care program on July 1, 2025, absorbing the members of an MCO that left the state, and it requires Electronic Visit Verification (EVV) to flow through HHAeXchange in the HHAv5 format rather than through the pipeline every other Virginia payer uses. For an agency that had one clean way of doing things, that is a real disruption, and the agencies that did not move quickly saw those visits stop paying.
Here is the background that makes the change so disruptive. For years, the way home care worked in Virginia was that claims and EVV data were sent together on an 837 claim with specially designed segments that carried Virginia's required EVV attribution: who the caregiver was, the latitude and longitude of the visit, or whether it was captured by telephony or a fixed-object (FOB) device. That attribution rode inside the claim, and most agencies uploaded everything the same way, usually to Availity for distribution and return. That is still how it works for all but two of the payers. The first exception has been true from the start: Anthem requires its visits to be submitted through Electronic Visit Verification to Netsmart, which many people still know as Tellus (Netsmart acquired Tellus). The second exception is the new one. When Humana came on the scene, it said it wanted EVV sent through HHAeXchange in the HHAv5 format. Making that kind of change, when your entire process outside of Anthem was to submit every claim the same way, has been a hardship for agency after agency.
This is a problem we understand well, and not in the abstract. Ankota has used the HHAeXchange HHAv5 format successfully in other states, so when a Virginia agency needs those Humana members verified and billed through HHAeXchange while everything else keeps flowing the way it always has, that is a path we have already walked. If you want the deeper background on how aggregators like HHAeXchange fit into the picture, our explainer on EVV aggregators and our guide to EVV software compatible with HHA Exchange both cover the mechanics.
DMAS forms matter because Virginia requires service documentation to be captured on DMAS-designated forms in the exact state-specified format, and the practical pain is not one missed checkbox, it is producing that precise format out of the software where you actually collect the information. Every client needs a set of these: the DMAS-97 care plan, the DMAS-99, and the DMAS-100. The state cares that the output matches its template, which is awkward when the natural place to gather the data is an intake or care-planning screen, not a PDF.
The way Ankota solves this is to let agencies work in one system instead of two. We built HTML forms that look very close to the DMAS forms, so the caregiver or coordinator fills them out inside Ankota. When they save, we transfer that data into the fillable PDFs in the exact Virginia state format. Nobody has to open a separate PDF somewhere else, retype the information, and upload it. It is fully integrated, which means the documentation is where the rest of the client record already lives.
There is a piece of Virginia history worth knowing here, because it still shows up in audits. Before Electronic Visit Verification went into place, the way agencies billed was by filling out a form called the DMAS-90. It is no longer required for billing, but it is the form auditors want to see if an agency is ever audited, because it shows the information the caregiver collected on each visit and the signatures that were captured. So the DMAS-90 lives on as an audit artifact, and Ankota produces it on demand for any historical visit. If you want to see how documentation ties into compliance more broadly, our EVV software page and the EVV reference guide both go deeper.
When a client's managed care organization changes without warning, the home care agency usually does not find out until the money stops, and by then several visits have already been rendered and billed to a payer the client no longer has. The rejection comes back saying the member is not part of that health plan, the agency tracks it down, and learns the client switched to another MCO three or six weeks ago. With five MCOs now operating under Cardinal Care, plan changes are a normal part of the landscape, and an open enrollment, a life event, or a simple solicitation can move a client without the agency ever hearing about it.
We've actually seen some of our customers struggle to get their clients paid through Humana, and then encourage those clients to move to a different MCO. I'm not sure that's what the state or anybody else intended, but it's one of the things that's happening.
Whatever the reason for the switch, the operational problem is the same: visits already carry the billing and EVV attribution for the old payer, and they need to carry it for the new one. This is a spot where Ankota makes the fix quick. As long as you know the start date with the new payer, or even the date range, you select that client and that date range, and we change the affected visits to carry the billing and Electronic Visit Verification attribution the new MCO requires. What could be a pile of manual rework becomes a targeted correction.
When a Virginia Medicaid client is hospitalized, their Medicaid waiver services are suspended, because the hospital becomes the health resource in charge rather than the home care agency, and that creates two separate billing traps that catch good agencies off guard. The first is that a caregiver sometimes goes to the hospital to provide companionship and care to their person, and that time gets denied. We generally see this as an honest mistake, not anyone trying to break the rules. The caregiver is caring for someone they are attached to, it has never come up before, and they did not realize that a visit inside the hospital simply cannot be billed.
The second trap is subtler and it is about where the claim goes after discharge. Say a Sentara client has a three-day hospitalization from June 5 to June 8. Often, for the stretch from June 9, when services can resume, through the end of that month, the visits are not billed to Sentara at all. They have to be billed to Medicaid directly, and then billing reverts to Sentara on July 1. An agency that does not know to reroute those visits will send them to the MCO, watch them deny, and spend the next month untangling it. Ankota is built to route these visits correctly through the suspension and the direct-bill window so the claims land where they are supposed to. For the wider pattern of avoiding preventable Medicaid denials, our article on Medicaid waiver billing and avoiding denials in HCBS is a good companion read.
You bill personal care and respite correctly in Virginia by keeping them completely separate, because the state prohibits billing personal care and respite at the same time, and layering whole-hour billing with monthly rounding rules on top means one tracking slip at month-end can cascade into a run of denied claims. Many agencies offer personal care on a regular weekly schedule and also carry respite units so the family can get an occasional break, and that respite is usually unscheduled, which is exactly where the tracking gets hard.
Ankota handles this at the point of care so the office is not reconstructing it later. When respite happens right after a personal care visit, the caregiver only has to clock in once, at the start of personal care. We know how much time is scheduled for personal care, so when that time runs out, we flip the visit over to respite, and we segment the personal care portion from the respite portion cleanly. That gives you the correct Electronic Visit Verification and billing attribution for the whole set of transactions without asking the caregiver to manage two clock-ins in the middle of caring for someone.
One thing varies across agencies, and we support both approaches. Some agencies treat the service delivered during respite as strictly respite. Others say that if the caregiver does something during the respite window that would normally be personal care, like preparing a meal or helping with toileting, they want that documented too. Ankota can track the respite time as its own service while still recording the personal-care-type tasks performed during it, so agencies on either side of that preference are covered.
Every one of these five challenges is a place where the software either quietly does the right thing or quietly lets a claim die. Ankota was built for the second half of that sentence never to happen. We already move Humana visits through HHAeXchange in the HHAv5 format, generate DMAS forms in Virginia's exact format from data your team enters once, re-attribute visits when a client's MCO changes mid-month, route hospitalization visits through the suspension and direct-bill window, and split personal care from respite to the minute. If you want to see how that works for your agency, take a look at our EVV software and our EVV reference guide, or just contact Ankota and we will walk your Virginia workflows end to end.
For the source documents behind these rules, Virginia publishes provider guidance through the DMAS provider portal, the July 1, 2025 Cardinal Care managed care changes are documented in the DMAS Cardinal Care bulletin, and the federal EVV mandate itself comes from the 21st Century Cures Act EVV requirements on Medicaid.gov.
Humana entered the Cardinal Care program on July 1, 2025, taking over the members of an MCO that left Virginia, and it requires Electronic Visit Verification through HHAeXchange in the HHAv5 format. Most Virginia agencies had been sending EVV attribution inside the 837 claim for every payer except Anthem, so Humana's requirement forced a new, parallel way of verifying and billing those specific visits. Agencies that did not adapt quickly saw those visits stop paying.
Which Virginia payers use a different EVV path from the standard 837 claim?Two. Anthem has always required its visits to be submitted through Electronic Visit Verification to Netsmart, the company that acquired Tellus. Humana, new as of July 2025, requires EVV through HHAeXchange in the HHAv5 format. Every other Cardinal Care payer still accepts the Virginia EVV attribution carried inside the 837 claim, typically routed through Availity.
Which DMAS forms do Virginia home care agencies need for each client?Every client needs a DMAS-97 care plan, a DMAS-99, and a DMAS-100, all in Virginia's exact state-specified format. Ankota collects the information on HTML forms that mirror the DMAS layouts, then writes the data into the fillable state PDFs on save, so agencies do not have to fill and upload a separate PDF outside their system.
Is the DMAS-90 still required?The DMAS-90 is no longer required for billing, since Electronic Visit Verification replaced that function, but auditors still want to see it because it documents the information a caregiver collected on each visit and the signatures captured. Ankota produces the DMAS-90 on demand for any historical visit, so it is available if an agency is ever audited.
How does an agency recover when a client changes MCO without notice?Usually the agency discovers the change only when claims deny with a message that the member is not part of that health plan. Once you know the start date, or the date range, with the new managed care organization, Ankota lets you select that client and date range and re-attribute the affected visits to carry the billing and EVV information the new payer requires, rather than correcting each visit by hand.
Why do hospital visits and post-discharge visits get denied?When a client is hospitalized, Medicaid waiver services are suspended because the hospital becomes the responsible health resource, so care provided in the hospital cannot be billed. After discharge, visits for the rest of that month often must be billed to Medicaid directly rather than to the MCO, reverting to the MCO on the first of the next month. Ankota routes visits correctly through both the suspension and the direct-bill window.
How does Virginia's rule against billing personal care and respite together work?Virginia prohibits billing personal care and respite for the same time, and both use whole-hour billing with monthly rounding, so overlaps or rounding mistakes lead to denials. When respite follows a personal care visit, Ankota lets the caregiver clock in once, then flips the visit from personal care to respite when the scheduled personal care time runs out, segmenting the two so each carries the correct EVV and billing attribution.
Can Ankota track personal-care tasks performed during respite time?Yes. Some agencies treat respite time as strictly respite, while others want to document when a caregiver performs a personal-care task during respite, such as preparing a meal or helping with toileting. Ankota supports both, recording the respite time as its own service while still capturing any personal-care-type tasks performed during that window.
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.