All states: EVV requirements map
In short: The EVV system depends on the payer. Medicaid Direct uses the free Sandata system, and your own EVV software is allowed. Claims without a verified visit are denied.
| EVV model | Open (provider choice). Use the payer's free system or your own EVV software. |
|---|---|
| State EVV system | Sandata, free, for NC Medicaid Direct. |
| Managed care EVV systems | HHAeXchange for most Standard Plans and all Tailored Plans. CareBridge for Healthy Blue. |
| Aggregator | Sandata. It collects all NC Medicaid visit data, whatever system captured it. |
| Can I use my own EVV vendor? | Yes. Your data goes to the payer's EVV vendor, and you register with Sandata. |
| Are claims denied without EVV? | Yes. Medicaid Direct personal care and CAP since June 1, 2021, and home health since October 1, 2023. |
| Managed care | Home health claims without EVV data are denied for dates of service from October 1, 2025. |
Last verified against state sources: 2026-10-08.
It depends on who pays the claim. NC Medicaid Direct uses Sandata as its free EVV system. The managed care plans use other systems: HHAeXchange for most of them, and CareBridge for Healthy Blue. Sandata is also the state aggregator, so every North Carolina Medicaid visit ends up there no matter which system captured it.
Each of these systems is free to providers. You can also keep your own EVV software. NC Medicaid says providers have a free choice of vendor and that it does not recommend vendors. If you use your own software, your visit data has to reach the EVV vendor for the payer you are billing: Sandata for Medicaid Direct, HHAeXchange or CareBridge for managed care. For managed care, the state advises allowing at least 10 business days for that integration. With Medicaid Direct, GPS confirmation is required when a third-party vendor is used.
Important: Register with Sandata even if you never use the Sandata system. HHAeXchange and CareBridge pass your visits on to the Sandata aggregator, but only once you are registered. Agencies with more than one NPI register each one, using the Sandata registration site linked from the NC Medicaid EVV page.
An agency that serves Medicaid Direct members and members of several plans will usually deal with more than one EVV vendor. Check each client's payer before the first visit, because the payer decides where the visit data and the claim have to go.
EVV applies to in-home personal care services, the CAP/C and CAP/DA waiver in-home services, home health visits, and certain Innovations and TBI waiver services. Personal care and CAP services have required EVV since January 1, 2021. Home health followed on April 1, 2023 for Medicaid Direct and the Standard Plans.
Some services are outside EVV. The state lists private duty nursing, CAP/C nurse respite, personal care delivered in assisted living, adult care and group homes, independent practitioner therapy and home infusion as not subject to EVV. Retainer plans of care are excluded too.
North Carolina exempts a paid caregiver who lives in the home with the beneficiary, for both agency and self-directed care. Staff who do not live in the home still have to use EVV. In CAP consumer direction, the participant or their designee is the employer of record and acts as the provider agency for EVV reporting.
Yes. NC Medicaid Direct has checked personal care and CAP claims against EVV data since dates of service June 1, 2021, and home health claims have needed verified visit data for payment since October 1, 2023. The managed care plans apply their own checks, and plans deny home health claims without the required EVV data for dates of service on or after October 1, 2025.
Plan documents add their own rules. UnitedHealthcare says personal care claims that did not come through its EVV vendor, HHAeXchange, are denied, and it requires billing taxonomy 251E00000X. Healthy Blue's billing guide says claims subject to EVV must be submitted through an EVV platform integrated with CareBridge, and that such claims keyed in by hand through its provider portal are denied. Alliance requires its EVV services to be captured and invoiced from HHAeXchange. We did not find the matching personal care rules for AmeriHealth Caritas, Carolina Complete Health, WellCare, Partners, Trillium or Vaya, so check with those plans directly.
NC Medicaid also expects manual visit entries to stay at 15 percent or less, with at least 85 percent of visits captured electronically. Manual entries alone do not cause a denial, but a visit that never reaches the payer's system in verified form is a visit that does not get paid.
We did not find an upcoming EVV vendor or rule change for North Carolina as of our last check. The NC Medicaid EVV page still names Sandata for Medicaid Direct, HHAeXchange for the Tailored Plans and most Standard Plans, and CareBridge for Healthy Blue. The last major step, the managed care home health hard launch on October 1, 2025, is already in effect.
In a June 2024 provider forum, the state listed client electronic signature verification and single sign-on through NCID as possible future projects, with no timeline. Neither has been announced as a requirement, so treat them as ideas to watch and not as rules.
Plans do send operational notices from time to time, such as rate updates that have to be entered in the plan's EVV system before billing. Watch the NC Medicaid EVV page and the provider bulletins of each plan you bill.
Leave your email and we will let you know when North Carolina changes its EVV requirements. No newsletter, only changes for this state.
Questions about North Carolina EVV rules are best put to the state. Start with NC Medicaid: Electronic Visit Verification. The state lists Medicaid.EVV@dhhs.nc.gov for EVV questions.
California, Colorado, Connecticut, Delaware, District of Columbia, Hawaii, Idaho, Indiana, Maine, Massachusetts, Missouri, Nevada, Ohio, Pennsylvania, Rhode Island, Vermont, Wisconsin. See every state on the EVV requirements map.
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 Medicaid home care agencies. If you would like to talk through North Carolina's requirements, contact Ankota or read more about Ankota's EVV software.
Mr. Dave Richard
North Carolina Department of Health and Human Services
1985 Umstead Drive, 2501 Mail Service Center
Raleigh, NC 27699-2501
