An EVV exception is a visit record that’s missing something your state needs before it will pay the claim, like a clock-out that never happened. EVV exceptions don’t announce themselves. Often the first sign is a short remittance weeks after the visit, when the caregiver can no longer tell you what time she left.
What is an EVV exception
EVV exception: a visit whose electronic record is incomplete or doesn’t match what the state requires, so the claim can’t be matched to a verified visit and paid.
Electronic visit verification, or EVV, is how Medicaid confirms that a visit in a client’s home happened the way it was billed. Section 12006 of the 21st Century Cures Act made it mandatory for Medicaid-funded personal care services by January 1, 2020, and Medicaid-funded home health services by January 1, 2023. Every visit has to capture six pieces of information, listed in CMS guidance on the Cures Act:
- the type of service performed
- the person receiving the service
- the date of the service
- where the service was delivered
- the person providing the service
- the time the service began and ended
If any of the six is missing, or doesn’t line up with the schedule and the client’s authorization, the visit lands on your exception report.
The most common exception reasons
EVV exceptions show up on the report with a reason attached, and each reason points to a different fix. Most of those fixes start outside the office, with a caregiver, a phone, or a schedule.
| Exception reason | What usually happened | What prevents the next one |
|---|---|---|
| Missing clock-in or clock-out | The caregiver forgot at the start or end of the shift, or the clock-in never went through | A walk-through of the app on a call, the same day it happens |
| Location doesn’t match | The visit was verified away from the client’s address, for example from the driveway or with a weak signal inside the home | Check the signal at that address and set up the backup verification method your state allows |
| Wrong caregiver or client | Someone used another caregiver’s login, or picked the wrong client from the list | Give every caregiver their own working login before their first shift |
| No matching shift | A call-off was covered by someone else, and the schedule still shows the original caregiver | Update the schedule the moment a shift changes hands |
| Time doesn’t match the authorization | The visit ran past the authorized units, or the authorization ran out | Check authorizations and remaining units before each billing run |
How one missed clock-out becomes an unpaid claim
Take a Tuesday afternoon visit. The caregiver finishes, settles the client in, and heads to her next shift without tapping clock-out. Nothing happens in that moment. The cost shows up later, one step at a time.
From a missed clock-out to a short payment
- The visitIt ends with no clock-out, so the record stays open.
- The next morningThe visit shows up on the exception report as a missing clock-out.
- Billing dayThe state’s system tries to match the claim to a verified visit, a step usually called claims matching.
- ProcessingWith no complete record to match, some states deny the claim. Others pay now and count the visit against you later.
- PaydayThe remittance comes in short, and the office has to rebuild the shift from memory.
Every day between the visit and the fix makes the fix harder. The morning after, the caregiver can tell you she left at 4:10. Three weeks later she’s guessing, and a guess is a weak thing to put in a visit record.
How that last step plays out depends on the state, and in 2026 several states moved EVV from paperwork into payment.
| State | What happens to a visit without a verified EVV record | In effect |
|---|---|---|
| Missouri | The claim is denied. The first deposit affected was April 24, covering claims processed on the April 10 remittance advice | Services on or after April 1, 2026 |
| Ohio | Claims without a matching EVV visit record are denied | Phased in since March 2025. PASSPORT waiver services since January 1, 2026 |
| Minnesota | Agencies must keep an EVV compliance rate of at least 80%, and corrected visits count against it. Payments can be withheld or recovered | Since July 1, 2026 |
Sources: MO HealthNet, March 30, 2026. Ohio Department of Aging, January 6, 2026. Minnesota DHS, updated July 23, 2026.
These rules change often, so check your state Medicaid agency’s EVV page before you change a process.
Why fixing EVV exceptions by hand can backfire
Most EVV systems let the office correct a visit after the fact, usually through a screen called visit maintenance. You add the missing clock-out, choose a reason code, and resubmit. That gets one claim paid. Repeat it often enough and the corrections turn into a compliance problem of their own.
Pennsylvania expects 85% of EVV records for verified visits to have no manual edits. Since January 2026, its Department of Human Services has alerted fee-for-service agencies whose manual edits passed 15% in the previous quarter, and two consecutive quarters above 15% bring a formal notice of noncompliance and a corrective action plan (PA DHS, August 29, 2025). Minnesota is stricter on the same point. A visit entered or corrected by hand counts as noncompliant, because it wasn’t verified in real time (Minnesota DHS).
So an agency that keeps up by editing is slowly building its own flag. The goal shifts from fixing EVV exceptions faster to producing fewer of them. When the same caregiver or the same address shows up week after week, the reasons table above tells you which fix to try first.
The morning check that keeps EVV exceptions small
The routine that keeps the list short isn’t complicated. It’s yesterday’s exceptions, worked before they age, plus a few checks on a slower rhythm.
Every morning
- Pull yesterday’s exception list before the phones take over the day.
- Sort it by exception reason, using the table above.
- Reach each caregiver the same day, while the shift is still fresh, and note why the record broke.
- Queue each correction with a reason code and a short note for the office to approve. No visit record changes without a second set of eyes.
Every week
- Track manual edits as a share of all visits. In Pennsylvania it’s the number the state watches. Everywhere else, it tells you whether the routine is working.
- Review denied claims by reason, not one by one, so patterns show up.
Before every billing run
- Confirm every claim line matches a verified visit, and billed units match the clocked time.
The morning EVV check
The full routine on one page: daily, weekly, billing-day, and quarterly checks, plus what changed in five states in 2026.
Who should own EVV exceptions
In most agencies, the person who’d work this list is the scheduler, and the scheduler is already busy covering tonight’s call-offs. The exception list loses that contest most days. A client without a caregiver can’t wait until tomorrow, and a missing clock-out can.
So EVV exceptions need an owner whose morning starts with them. That can be a coordinator in the office, a protected first hour of the scheduler’s day, or a remote team member who works the list inside your EVV and scheduling software. Whoever owns it, the office approves every correction.
The third option is what Teem does. Our home care virtual assistants are remote team members who work only for your agency, on your schedule. They clear EVV exceptions, reach caregivers, and queue corrections for your approval, and they’re HIPAA trained and work over a secure VPN. Your scheduler gets room to breathe.
If your EVV exceptions have been piling up quietly behind the call-offs, tomorrow morning is a good place to start. Pull yesterday’s list, call the first caregiver on it, and see what she remembers.
EVV exceptions FAQ
What causes EVV exceptions?
Missed clock-ins or clock-outs, a location that doesn’t match the client’s address, a visit recorded under the wrong caregiver or client, a visit with no matching shift, and visit times that don’t fit the client’s authorization.
Can an EVV exception be fixed after the visit?
Yes, through visit maintenance in your EVV system, usually with a reason code. Each state sets how late a fix can happen and whether it counts against you.
Does EVV apply to private-pay clients?
The federal requirement covers Medicaid-funded personal care and home health services. Private-pay visits fall outside it, though some agencies run EVV on every visit to keep one routine.
What’s the difference between an EVV exception and a denied claim?
An EVV exception is a problem with the visit record. A denial is the payer refusing a claim that has no matching verified visit. Clearing EVV exceptions before you bill is what prevents the denial.
How many manual edits are too many?
It depends on the state. Pennsylvania alerts agencies whose manual edits pass 15% in a quarter, and Minnesota requires an 80% compliance rate in which corrected visits count as noncompliant. Your state Medicaid agency’s EVV page has the current rule.
