What Florida requires
Oct 1, 2024
AHCA switched its designated EVV aggregator from Netsmart to HHAeXchange. Florida runs an open model: use the designated aggregator free, or an alternate vendor that integrates with it.
Source: AHCA home-health EVV program / HHAeXchange
Jan 30, 2025
Sunshine Health stopped accepting EVV claims that were not electronically confirmed or missing appropriate visit exception reasons.
Source: Sunshine Health provider notice
Standing rule
Under Rule 59G-9.070, EVV non-compliance exposes providers to claim denial or non-payment, sanctions, fines, and suspension or termination from Florida Medicaid.
Source: Florida Administrative Code 59G-9.070
Billing trap
Billing provider information must exactly match the NPI that AHCA has on file, or encounters are denied.
Source: Molina Healthcare FL provider guidance
Edit-rate / usage rule
Florida publishes no numeric edit ceiling, but rule 59G-9.070 makes EVV non-compliance a sanctionable event — and individual plans have already stopped accepting unconfirmed claims.
Why the 2024 aggregator switch still bites
Agencies whose EVV vendor was integrated with Netsmart had to re-establish that integration with HHAeXchange when AHCA switched aggregators. Visits that stopped flowing after October 2024 — because a feed was never re-pointed — surface later as unmatched claims. If your denials started clustering after the switch, check the vendor-to-aggregator connection before anything else.
Because Florida is an open model, the responsibility for the pipe sits with you: the designated aggregator path is free, but an alternate vendor is only compliant if it actually integrates with HHAeXchange.
Plan-level enforcement moves faster than state-level
Florida's managed-care plans are enforcing EVV confirmation on their own timelines — Sunshine Health's January 2025 cutoff is the visible example. That means your effective enforcement date is whichever of your plans moves first, not a single statewide date. Watch each plan's provider notices, and treat the strictest plan's rule as the house rule.
With one of the country's largest 65+ populations, Florida's home-care claim volume makes even a small mismatch rate expensive — the same percentage gap costs a Florida agency more dollars than it costs almost anywhere else.
What are Florida EVV denials costing you?
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