What Pennsylvania requires
Since Jan 1, 2025
At least 85% of EVV visits must be verified without manual edits (no more than 15% manually edited), measured quarterly, per payer (MA Bulletin, Aug 23, 2024).
Source: PA DHS MA Bulletin 8/23/2024
Two quarters
Miss the threshold two quarters running and DHS requires a corrective action plan.
From Jan 2026
DHS issues quarterly alerts to providers whose manual-entry percentage exceeds 15% for the previous quarter, ahead of any corrective action plan.
Edit-rate / usage rule
Pennsylvania requires at least 85% of EVV visits verified WITHOUT manual edits, quarterly, per payer. Two quarters under triggers a corrective action plan.
The ESC codes on your remittance advice
Pennsylvania reports EVV outcomes as Error Status Codes on the Remittance Advice, in parallel pairs — personal care first, home health ten higher: 925/935 visit verified (informational — the good one); 926/936 duplicate visits, denies; 927/937 units billed exceed verified units, denies with NO automatic cutback; 928/938 no matching visit, denies; 929–931 system timeouts that suspend the claim (Gainwell normally reprocesses within 24 hours); 933 format error, most often a claim line spanning 31+ days.
Because ESCs ride the RA rather than the 835 file, an 835-only analysis under-counts PA-specific EVV activity — worth knowing before concluding a remittance is clean.
The trap DHS names most: 9 digits where 10 belong
DHS's own guidance calls out one cause as frequently seen behind 928/938 denials: claims billed with the 9-digit MA ID where the 10-digit recipient RID is required. If you're staring at a wall of 928s, check the recipient identifier format before anything else.
Also DHS-sanctioned: for 2:1 care where a third worker's time overlaps, manually shifting that worker's time so the records don't collide is the approved fix.
Why the edit rate is the real game
Every manual edit that rescues a visit also counts against the 85% measure. An agency can clear every denial and still fail compliance if a third of its visits needed hand-editing to get there. The durable fix is upstream: caregivers clocking in correctly, identifiers right at intake, and billing held until visits verify.
What are Pennsylvania 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-RayStop the Pennsylvania denials, not just measure them
The X-Ray tells you what EVV is costing you. These fix it. Flat monthly fee — never a percentage of what you collect, which federal Medicaid rules forbid (42 CFR 447.10).
Monitor
$99/mo
Same-day missed-punch alerts, a monthly caregiver exception scorecard, and an edit-rate watch set to Pennsylvania's line. You upload, we flag. Starts immediately.
Denial Desk
from $995/mo
A named US-based coordinator works your exceptions and drafts every correction with its reason code and evidence snapshot. A person signs off, not a bot.
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