MedicaidDocumentationHigh impact
Newsletter Vol. 33, No.14
New Jersey Medicaid·NJ · Physical Therapy, Occupational Therapy, Speech Therapy +2 more·Provider Notice
Effective date
Jan 1, 2023
We identified it
Jun 20, 2026
Summary
New Jersey implemented Electronic Visit Verification (EVV) compliance requirements for home health care services, personal care assistance, and developmental disabilities services effective January 1, 2023. Providers must capture and report six required data elements (service type, recipient, date, location, provider, start/end times) through HHAeXchange, CareBridge, or approved third-party EVV systems. Claims will not be paid without EVV compliance; providers must track compliance metrics for each payer separately.
Action Required
By January 1, 2023 (RETROACTIVE - this policy is now in effect): Billing team must ensure all home health care, personal care assistance, and DDD-related service claims include complete EVV data submission. REQUIREMENTS: (1) Confirm provider has registered with HHAeXchange provider portal and downloaded current service rates for all payers (Aetna, UHC, Fidelis Care, Amerigroup, Horizon, and FFS Medicaid); (2) Implement system to capture and verify all six EVV data elements before claim submission: type of service, individual receiving service, date, location, individual providing service, start/end times; (3) For claims using CareBridge (Amerigroup/Horizon members): ensure member information is entered in CareBridge or Navinet before billing; (4) Establish compliance tracking for each MCO/FFS separately using the compliance calculation methodology outlined in Section E; (5) Update billing workflows to batch and submit visits through EVV system before creating invoices; (6) Review all pending/denied home health claims from 2023 forward and resubmit with complete EVV data if rejected. Consequences: Claims without complete EVV data will be denied; providers must maintain minimum compliance thresholds to stay in good standing with each payer; non-compliance may result in contract termination.