North Carolina Medicaid: EVV requirements upheld for PCS providers

Use HHAeXchange for data transmission

As a personal care service (PCS) provider for Standard Plans and Tailored Plans in North Carolina, you’re required by the state to follow its electronic visit verification (EVV) standards. For each service encounter with the member, you must:

Accurately capture PCS hours using a mobile application, telephony or a Fixed Visit Verification (FVV) device
Maintain records to confirm all tasks in the PCS service plan are completed as scheduled
Document the name of the aide providing care, the date of service and tasks performed
Record any deviations from the service plan and explain missed or altered tasks
Electronically transmit encounter data to the state. You’ll use HHAeXchange, our EVV vendor, for UnitedHealthcare transactions.

Note: You will not be compliant if you submit EVV data and the claim to UnitedHealthcare directly. We will deny claims for encounter visits that did not come to us through an EVV vendor.

EVV registration and training

Prepare for EVV requirements with the following steps:

Register with HHAeXchange by completing the North Carolina PHP HHAeXchange Provider Enrollment Form
Ensure the agency staff completes HHAeXchange University training

How to submit data

Verify the encounter information and claim for accuracy:
- The EVV service codes transmitted to HHAeXchange must exactly match what you submitted to UnitedHealthcare for prior authorization approval
- The taxonomy code entered on the claim must match the PCSs you’re authorized to perform. You must bill under taxonomy code 251E00000X or the claim will be denied.
You only need to make one submission for both transactions:
- You or a third-party EDI vendor transmits EVV and claim data directly to HHAeXchange
- HHAeXchange will send the data to UnitedHealthcare for claim processing

Tips for remaining compliant

Follow due process for EVV requirements and proper claims processing:

Confirm your vendor successfully imported the visit date into HHAeXchange
Work with your vendor to monitor and resolve visit import failures
Check UnitedHealthcare claim status to validate HHAeXchange exported the EVV data
Regularly review and resolve prebilling and billing holds
While you’re required to use EVV to capture data from visits, manual entries are permitted up to 15%, if necessary. North Carolina Medicaid regularly monitors the percentage of manual submissions by providers.
Removing or failing to follow the service plan constitutes non-compliance and may result in a Program Integrity audit. Non-compliance may also impact the authorization and continuation of PCS services.

Additional resources

North Carolina Medicaid: State Plan Personal Care Services, Clinical Coverage Policy, Section 7
North Carolina 2026 Care Provider Manual: Electronic visit verification for Personal Care Services

Questions? We’re here to help.

Connect with us through chat 24/7 in the UnitedHealthcare Provider Portal. If you don’t have access to the portal, you can reach us directly at ncevv@uhc.com. For questions about EVV system integration, open a ticket with HHAeXchange support.