Pennsylvania's 85% EVV edit-rate threshold, explained

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.