What Ohio requires
Mar 1, 2025
Home-health claims billed to ODM began requiring a matching EVV visit; other provider types phased in from June 2025, completing by the end of Q1 2026.
Source: ODM EVV rollout schedule
Jan 1, 2026
ODM hard-denies personal-care and waiver claims that have no matching EVV visit on file.
Source: Ohio Department of Medicaid EVV policy
Mar 1, 2026
MyCare Ohio waiver claims joined hard denials (per CareSource's provider guidance). Before that date, MyCare plans printed N363 alerts on claims that would have failed.
Source: CareSource EVV FAQ
CY2022 review
The Ohio Auditor of State found about $1.1 billion of roughly $2 billion in paid home-care claims (about 56%) had no matching EVV visit record — a verification gap, not a finding of fraud. Only 28% of EVV entries were in Verified status, and 34% had been manually adjusted.
Source: Ohio Auditor of State, Nov 2024
Edit-rate / usage rule
Ohio has no fixed manual-edit ceiling, but every unverified or hand-edited visit is a claim that can hard-deny and an audit exposure — the Auditor's 34%-manually-adjusted figure is the number to beat.
The four errors, and how each program spells them
Ohio publishes exactly four common EVV errors, and each appears under different codes depending on the program paying the claim. Provider ID not matched: ODM/MCO remittances show CARC 272 + N521, DODD's eMBS shows Error 70, AGE shows EV000/EV002. Recipient not matched: 272 + N819 (DODD Error 71). No verified visit for the service: 272 + N56 (DODD Error 66). Units insufficient: 272 + N820 (DODD Error 67).
The pay condition underneath all four is the same: the visit must reach 'Verified' status in the Sandata aggregator before the claim. A visit stuck in Processed or Incomplete status does not count, no matter how real the care was.
Red dots and grey dots: what actually needs fixing
Inside Sandata, exceptions carry a triage color. RED exceptions block verification and must be fixed: missed call-in or call-out, missing or unauthorized service, unknown recipient or caregiver. GREY/YELLOW exceptions only need acknowledgment: GPS location variance, skipped verification prompts, missing client signature.
Agencies that burn time hand-working grey exceptions while red ones sit are fixing the wrong queue — the reds are the ones holding your money.
MCO behavior worth knowing
CareSource states it will NOT adjust EVV denials on its side: the provider fixes the visit, waits for it to re-export and reach Verified, then resubmits the claim. Build that resubmission loop into your workflow rather than waiting on plan-side reprocessing.
What are Ohio EVV denials costing you?
The free X-Ray reads your Medicaid 835 in your browser and shows the EVV denials. The file never leaves your computer.
Run the free Denial X-Ray