EVV Exception Codes and Visit Corrections
An EVV exception is a visit that did not verify cleanly. Fix it with the state's reason code, a note and approval, inside the correction window, and keep the original.
By Caregiver Scheduling Team ·
An EVV exception is a visit record that did not verify cleanly: a missing check-in or check-out, a GPS point outside the geofence, or a visit that does not match the schedule or authorization. Fixing one means editing the record with a reason code your state accepts, adding a short note, getting supervisor approval where required, and doing all of it inside your state’s correction window. Each state publishes its own code list.
What triggers an EVV exception?
Anything that leaves one of the six federal data elements missing or inconsistent. Under the 21st Century Cures Act, an EVV system must verify the type of service, the individual receiving it, the date, the location, the individual providing it, and the start and end time (42 U.S.C. 1396b(l)). A visit that fails on any of those sits in exception status until someone resolves it, and most states will not pay a claim for an unverified visit.
| Exception | Common cause | Typical fix |
|---|---|---|
| Missing check-in or check-out | Caregiver forgot to clock, phone died | Enter the actual time with a reason code |
| Location outside geofence | Weak GPS, visit started in the driveway, community outing | Confirm location and explain |
| Unknown client or caregiver | Wrong ID entered on telephony, new hire not loaded | Correct the ID, then re-verify |
| Unscheduled visit | Visit happened but no schedule or authorization matched | Link to the schedule or authorization |
| Duration mismatch | Visit much shorter or longer than scheduled | Confirm actual times with the caregiver |
| Missing or unauthorized service | Service code blank or not valid for the client | Update the service code |
| Call from an unregistered phone | Telephony call from the caregiver’s cell | Reason code plus approval |
Ohio’s exception list, for example, includes unknown client, unknown employee, visit without an in-call, visit without an out-call, missing service and unauthorized service. The state notes that an out-call must be made within 24 hours of the in-call and that these exceptions must be fixed before the visit is verified and eligible to match a claim.
What is a reason code, and who picks it?
A reason code is the state’s standard explanation for why a visit was entered or edited by hand. Office staff pick it; the caregiver should not choose codes for their own visits.
The Texas HHSC EVV Policy Handbook uses codes such as 110 A (service delivery differs from schedule), 110 B (downward adjustment of bill hours), 110 D (allowable overlapping visits), 210 I (emergency) and 600 (other). Texas requires free text only for 210 I and 600, but reviewers can read that text during compliance reviews, so write it as if an auditor will. Whatever your state’s list looks like, the test is the same: could a stranger read the code and note and understand what happened?
How long do you have to correct a visit?
It depends on the state, and the window is firm. In Texas, visit maintenance, including manual visit entry, must be finished within 95 calendar days of the date of service. After that the system locks the visit, and only a payer-approved Visit Maintenance Unlock Request reopens it. Texas says payers will not approve an unlock when a worker simply failed to clock in or out and the visit could have been entered in time.
The practical rule is to clear exceptions daily, not at month end. Late corrections also delay billing, which is how exceptions turn into EVV claim denials.
How many exceptions are too many?
States are starting to score it. Texas calculates an EVV Usage Score from manually entered and rejected visit transactions, and providers must keep a minimum score of 80% each state fiscal quarter. A first miss brings a notice and required training; repeat misses bring a corrective action plan and can lead to contract termination.
Track exceptions per caregiver each week. Coaching the few who generate most missed clock-ins, or fixing their GPS problem, moves the number more than any office process. Check your state’s rules in the EVV state directory.
What does a correction process that survives an audit look like?
- Review the exception queue every morning.
- Confirm actual times with the caregiver, and with the client if the two disagree.
- Apply the state reason code and a short, factual note.
- A supervisor approves the change.
- Keep the original record and the correction; never overwrite.
- Log who changed what and when, and keep it for your state’s EVV retention period.
Step 5 matters most: reviewers want the raw check-in data and the edit side by side.
How Caregiver Scheduling handles this
When GPS cannot confirm a location, the caregiver records an override reason in the app and the office reviews it from the dispatch screen. Every edit to a visit writes to the audit log, so the original and the correction are both kept with the name of the person who made the change. $199/month for up to 10 caregivers or $299/month for up to 50, free for 30 days.
FAQ
Are EVV exceptions always a problem? No. Some are normal, like a client who lives where GPS is weak. Frequent, unexplained or late corrections are what attract audits.
Who can approve a correction? Usually a supervisor or administrator under your written policy, and in most states not the caregiver who worked the visit.
Can I correct a visit after the state’s window closes? Often only with payer approval, and only for system errors or declared emergencies. Plan on the window being final.
Do I need reason codes for private-pay visits? Not legally, but using the same process for every visit keeps the habit and the audit trail consistent. See does EVV apply to private pay.
This article is general information, not legal advice. Check your state’s EVV policy.