Electronic Visit Verification (EVV) in Idaho
All states: EVV requirements map
In short: Open model with no state EVV system. Agencies choose a vendor that feeds the Sandata aggregator. Personal care and home health claims are denied without a matching visit.
Idaho EVV at a glance
| EVV model | Open (Provider Choice). Agencies pick and pay for their own EVV software. |
|---|---|
| State EVV system | None. Idaho does not provide a visit capture system. |
| Aggregator | Sandata EVV Aggregator |
| Can I use my own EVV vendor? | Yes. The vendor must be certified and compatible with the Sandata aggregator. |
| Are claims denied without EVV? | Yes. Personal Assistance Agency services since September 1, 2021 and home health since October 1, 2021. |
| Services in scope | Home health, State Plan personal care, and Aged and Disabled Waiver attendant care, homemaker and respite. |
| Managed care | We did not find EVV claim rules published by Idaho's Medicare and Medicaid duals plans. Check with the plan. |
Last verified against state sources: 2026-10-08.
How does EVV work in Idaho?
Idaho uses an open EVV model, which the state calls Provider Choice. There is no state-run EVV app. Each agency chooses and pays for its own EVV software, and that software sends visit data to the state's aggregator, which is run by Sandata. Any vendor can be used as long as it is certified and compatible with the Sandata EVV Aggregator.
The rule behind this is IDAPA 16.03.26.054. It requires a provider of an EVV service to:
- Select and maintain a certified EVV system.
- Obtain participant consent.
- Keep written EVV policies and procedures.
- Submit EVV data to the state aggregator before billing.
Each visit record has to carry the six federal EVV data elements. Sandata also provides the certification and training materials for the aggregator, and the Idaho Department of Health and Welfare (DHW) keeps reference documents in its EVV Library.
Which Idaho Medicaid services require EVV?
EVV applies to three groups of services in Idaho: home health, State Plan personal care services, and Aged and Disabled (A&D) Waiver attendant care, homemaker and respite. These are the only services the current rule lists. If you bill one of the codes below, the visit needs an EVV record.
- Personal Assistance Agencies: Attendant Care (S5125), Homemaker (S5130), Respite (T1005) and Personal Care Services (T1019).
- Home health agencies: revenue codes 0421, 0431, 0441, 0470, 0471, 0472, 0551 and 0571. The rule requires home health agencies to submit claims using EVV for all services except medical supplies and equipment.
Important: Private duty nursing is not on Idaho's current EVV scope list. Skilled nursing visits billed by a home health agency under revenue code 0551 are a different service, and those visits are in scope.
State Plan personal care billed as T1019 is in scope whatever the participant's age. Adult and children's developmental disability services are outside EVV scope, and DHW's EVV FAQ says Residential Habilitation is not subject to EVV. The rule also does not list self-directed community supports. An agency that bills both kinds of service only needs visit verification for the in-scope codes.
Does Idaho deny Medicaid claims without a matching EVV visit?
Yes. When a claim comes in for an EVV service, Idaho Medicaid looks for a matching visit in the aggregator. The claim pends for up to 10 days while the system looks for the visit, and it is denied if no match is found. This check has been in place since 2021:
- September 1, 2021: pend and deny validation began for Personal Assistance Agency services (S5125, S5130, T1005 and T1019). The state had first announced July 1, 2021 and then moved the date.
- October 1, 2021: denials for missing EVV began for home health claims.
The rule says the same thing in plain terms. IDAPA 16.03.26.545 states that claims for Attendant Care, Homemaker and Respite require EVV compliance to be reimbursable, and IDAPA 16.03.26.054 requires EVV data to reach the aggregator before the claim is billed.
Idaho also watches how visits are captured, not only whether they exist. The Bureau of Long Term Care (BLTC) reviews Personal Assistance Agencies each quarter and expects at least 85% of visits to be automatically verified, meaning they did not need manual correction. After a second deficient quarter in a row, the agency is asked for an EVV Action Plan. An agency that does not respond faces a Medicaid claims payment hold and a referral to the Medicaid Program Integrity Unit. In practice, agencies that review exceptions every day stay well clear of both the denials and the 85% threshold.
What is changing next for Idaho EVV?
We did not find any upcoming change to Idaho's EVV requirements in state sources as of our last check. The Provider Choice model, the Sandata aggregator and the claim checks described above are all current. The EVV rule text in IDAPA 16.03.26 carries a July 1, 2026 effective notation.
Two things are worth knowing while you watch for updates:
- Managed care: DHW's managed care page says the move of Idaho Medicaid to managed care is delayed to January 1, 2030. That page says nothing about EVV.
- Duals plans: we did not find published EVV claim rules from the plans that serve people with both Medicare and Medicaid. If you bill one of those plans for an EVV service, ask the plan how it handles visit verification.
DHW posts provider updates in the MedicAide newsletter and on its Long-Term Care Provider Resources page. Those are the places to check for any change.
Get notified when Idaho EVV rules change
Leave your email and we will let you know when Idaho changes its EVV requirements. No newsletter, only changes for this state.
Who to ask about Idaho EVV
Questions about Idaho EVV rules are best put to the state. Start with Idaho DHW: EVV frequently asked questions. The state lists EVV@dhw.idaho.gov for EVV questions.
Idaho EVV sources
- Idaho Medicaid Provider Handbook: General Billing Instructions (section 1.4, EVV)
- IDAPA 16.03.26 (current rule text, sections 054, 244 and 545)
- Idaho Medicaid EVV flyer (Provider Choice model)
- MedicAide newsletter, July 2021 (Personal Assistance Agency claim validation date)
- MedicAide newsletter, September 2021 (home health claim denials)
- Idaho DHW: EVV frequently asked questions
- Idaho DHW EVV Library: Idaho Validated Alt EVV Vendors
- Idaho DHW: Long-Term Care Provider Resources
- Idaho DHW: Medicaid managed care
Related reading
- EVV Software Compatible with Sandata Aggregator
- EVV Aggregators Explained: A Simple Guide for Home Care Providers
- Field guide: The Omit-and-Resubmit Method for Sandata
- The Benefits of Using 3rd-Party EVV Software
- EVV Software Demo Checklist: What to Ask and Test Before You Buy
- EVV requirements for every state (map)
Other states that use Sandata
California, Colorado, Connecticut, Delaware, District of Columbia, Hawaii, Indiana, Maine, Massachusetts, Missouri, Nevada, North Carolina, Ohio, Pennsylvania, Rhode Island, Vermont, Wisconsin. See every state on the EVV requirements map.
Page history
- October 8, 2026: Page rewritten and checked against state sources.
This page is a reference, not legal advice. State rules change, so confirm details with the state before you act on them.
Ankota provides EVV software for Idaho home care agencies and is on the state's validated EVV vendor list. If you would like to talk through Idaho's requirements, contact Ankota or read more about Ankota's EVV software.
Mr. Matt Wimmer
Division Administrator for Medicaid
Idaho Department of Health and Welfare
450 West State Street,
PTC Building, 10th Floor
Boise, ID 83705