Guide to Community HealthChoices (CHC) Enrollment & Electronic Visit Verification (EVV) Requirements for Home Care Agencies in Pennsylvania

Introduction

If you operate a home care agency in Pennsylvania, or plan to, understanding how to enroll as a CHC provider and comply with EVV requirements is essential. CHC governs long‑term services and supports for many Medicaid recipients, and EVV is now mandatory for many home- and community-based services. Failing to meet CHC or EVV requirements can result in denied claims, payment delays, or loss of contracts.

This blog dives deeply into:

• What CHC enrollment involves for a home care agency

• Key steps and documentation required

• What the EVV mandate requires, why it matters, and how to implement it properly

• Technical considerations when selecting or integrating an EVV system

• Practical tips and recommended best practices for smooth compliance

At the end you’ll have a clear roadmap for enrolling with CHC and using EVV correctly, which helps ensure proper billing, compliance, and quality of care.

Part 1: What is Community HealthChoices (CHC) and Why It Matters

Community HealthChoices (CHC) is Pennsylvania’s managed‑care program for long‑term services and supports (LTSS), overseen by Pennsylvania Department of Human Services (DHS) and executed through Managed Care Organizations (MCOs). Providers, including home care agencies, must contract with CHC MCOs to deliver Medicaid-funded services under waiver or managed‑care plans.

Who CHC Serves

CHC primarily targets:

• Older adults needing long-term or personal assistance services

• Individuals eligible under various waiver programs for personal care, home health aide services, respite care, in-home and community supports, and other long-term care services

By being part of CHC, home care agencies can access a broad population of Medicaid-covered clients, which often translates to steady referrals and payments, making CHC participation a strategic step for agencies.

Why CHC Enrollment Is Important for Home Care Agencies

• It provides access to a large population of clients who rely on Medicaid for LTSS.

• CHC manages authorizations, care plans, and billing through MCOs, handling a substantial portion of administrative burden and ensuring regulatory compliance.

• Enrollment demonstrates your agency meets the state’s standards, a trust signal for clients and referral sources.

Because many waiver-funded and Medicaid-funded services require CHC enrollment, ignoring CHC means missing out on a substantial client base.

Part 2: Steps to Enroll as a CHC Home Care Agency Provider in Pennsylvania

To become a CHC‑contracted provider, your agency must go through a formal enrollment process. While exact steps may vary depending on the MCO, the general process is consistent. Here’s how to get started:

Step 1: Ensure Your Agency Meets Eligibility Requirements

Before applying, confirm your agency meets state and MCO standards. Typical prerequisites include:

• Proper agency licensing and compliance with state regulations for home care / long-term services

• Adequate staffing, credentialed caregivers (where applicable), and ability to provide required services (personal care, home health aide, etc.)

• Administrative capacity: record‑keeping, scheduling, billing systems, and readiness to comply with EVV

Because CHC covers personal assistance services (PAS), home health aide services, respite, and other services under waiver plans, your agency’s service offerings must align with the scope defined under CHC waiver programs (e.g., under the Office of Long-Term Living or other relevant waiver).

Step 2: Complete the CHC Provider Enrollment Application

To enroll, your agency must submit a provider application to the relevant MCO(s). For many MCOs, this involves filling out a “Homecare Provider Questionnaire” or equivalent.

Important elements of the application:

• Agency information: legal name, address, ownership structure, licensing credentials

• Services to be provided under CHC (e.g., personal assistance, home health aide, respite, community support)

• Caregiver/staff information and credentials

• Agreement to comply with state and federal requirements, including EVV and reporting obligations

After submission, the MCO reviews the application, may request additional documentation, and upon approval includes your agency in its provider panel. Agencies typically receive access credentials to platforms used by the MCO for authorizations and claims billing.

Step 3: Register with the System That Handles Authorizations, Claims & EVV

Most CHC MCOs in Pennsylvania use a centralized platform to manage authorizations, scheduling, visit verification, and billing. One prominent platform is HHAeXchange.

After your agency is approved:

• Complete the HHAeXchange Provider Enrollment Form.

• Once onboarded, you’ll receive access to the portal, which supports scheduling, authorizations, EVV, and claims billing.

Your agency then has two main options for EVV compliance (discussed more below).

Step 4: Indicate EVV Capability During Enrollment

As part of CHC and Medicaid participation, you must declare whether you will be providing services subject to EVV (personal care services, home health aide services, home health care services). In the enrollment or revalidation application (via DHS’s PROMISe or the MCO’s provider onboarding), there will be a prompt to indicate this.

If you fail to indicate EVV capability, claims for EVV‑required services may be rejected or payment retracted.

Step 5: Complete MCO/CHC‑Specific Requirements

After your initial provider application, MCOs may require additional contract agreements, provider orientation, submission of documentation (e.g., proof of liability insurance, background checks, compliance with EVV), and system set‑up or portal training depending on the MCO.

Make sure to review each MCO’s provider manual or onboarding packet for due requirements.

Step 6: Begin Receiving Authorizations & Providing Services

Once enrolled and approved:

• You’ll receive member placements and service authorizations through the MCO’s portal.

• You can schedule your caregivers and begin providing services.

• All in‑home visits must be logged through an approved EVV system before billing.

Part 3: Understanding EVV Requirements in Pennsylvania

A critical component for CHC participation is compliance with EVV. This is mandated at state level under federal law.

What is EVV and Why It Exists

Electronic Visit Verification (EVV) is a system designed to verify that Medicaid-funded home care services, especially personal care services (PCS) and home health care services (HHCS), actually occur, at the time and place documented. The mandate arises from the federal 21st Century Cures Act.

EVV aims to:

• Prevent fraud and abuse (false claims for services not rendered)

• Ensure transparency and accountability in home-based services

• Protect clients by verifying actual visits occurred by actual caregivers

In Pennsylvania, EVV is mandatory for:

• Personal Care Services (PCS), activities including ADLs (bathing, hygiene, transferring, toileting) or IADLs (meal prep, shopping, etc.) under waiver or CHC services.

• Home Health Care Services (HHCS), home health aide services and other in‑home skilled or paraprofessional services; EVV requirement for HHCS fully applied from Jan 1 2024 (with soft launch earlier).

If your agency bills Medicaid for such services, claim lines submitted without a matching EVV record will be denied.

The Six Mandatory Data Elements

Under EVV, each visit must record six critical data elements to comply with the federal standard and PA‑DHS requirement:

The type of service provided

1. The individual receiving the service (client)

2. The individual providing the service (caregiver)

3. The physical location of service delivery

4. The date of service

5. The time the service begins and ends

Without these, EVV is considered invalid, and associated claims may be rejected.

What Happens If EVV Compliance Is Not Met

For many MCOs under CHC, EVV compliance is closely monitored. For example:

• Some MCOs (or their plans) have set thresholds for verified EVV records: for claim acceptance, a certain percentage of visits must be auto‑verified without manual edits.

• Claims lacking EVV match are denied.

• Repeated or systemic non‑compliance can lead to audits, corrective action plans, or even contract termination with an MCO.

Given these stakes, proper EVV system selection and implementation is not optional, it’s critical for a sustainable agency.

Part 4: EVV System Options: Choosing What Works for Your Agency

As a Pennsylvania home care agency under CHC, you essentially have two main EVV system options:

1. Use the MCO‑provided EVV platform (e.g., HHAeXchange)

2. Use your own (third‑party or proprietary) EVV system, provided it is certified/compliant and can integrate with the state’s EVV Aggregator

Option 1: Using the MCO‑Provided EVV Platform (HHAeXchange)

Many CHC MCOs partner with a centralized EHMR/EVV system, commonly HHAeXchange, which provides a turnkey solution to manage:

• Authorizations and care plans

• Scheduling and visit tracking

• EVV: clock-in/clock-out, telephony or mobile app, GPS/location, visit verification

• Claims billing and submission

Advantages:

• “Out-of-the-box” compliance: since HHAeXchange is already approved and integrated with the state aggregator, using it ensures your EVV data will be accepted without complex technical integration.

• Less technical burden: you avoid having to build or configure your own EVV; no need for custom integration or EDI development.

• Single portal for scheduling, authorizations, EVV, billing, which helps streamline workflows.

Implementation Steps:

1. Upon CHC provider approval, complete the HHAeXchange Provider Enrollment Form.

2. HHAeXchange sets up portal access, caregiver/user accounts, scheduling, and EVV tools (e.g., mobile apps, telephony).

3. Train staff and caregivers on using the system, clocking in/out, and capturing required data elements.

4. Begin logging visits, ensure every visit under PCS or HHCS is recorded via EVV before submitting claims.

Considerations:

• For some agencies with high volume or complex schedules, performance and user interface experience matter.

• Agencies must ensure that caregivers have devices (smartphones or access to telephony) that meet technical requirements.

• Training and compliance monitoring are essential to keep EVV match rates high to avoid rejections.

Option 2: Using Your Own Alternate EVV System

If your agency prefers, or already has, an EVV or agency management system, you can elect to use it, as long as it can interface with the state’s EVV aggregator and meet technical/data requirements.

Key Requirements and Steps:

• Your system must capture the six required data elements per visit (service type, client, caregiver, start/end times, date, location).

• The system must be capable of generating data files (or real-time API/EDI) in the format accepted by the state EVV Aggregator. For example, through standard data specifications used by the aggregator (such as those used by vendor systems like Sandata).

• Ensure configuration of correct contract type and service codes within the system based on the waiver or payer program: e.g., OLTL, waiver type, etc.

• Configure valid “Reason Codes” for missed, changed, or canceled visits (if applicable), to ensure accurate reporting of exceptions in EVV.

• Enter member (client) details properly, including first/last name, Medicaid ID (10-digit numeric), correct address and contact info, since the aggregator relies on accurate data.

• Enter caregiver info properly, first/last name, and for reporting either SSN (last five digits acceptable) or unique registry ID if assigned.

• Open a support/configuration case with the aggregator (or vendor) to establish the interface so that your EVV data is properly transmitted.

• Test thoroughly before live use, ensuring visits logged by your system appear in the aggregator, error codes are resolved, and billing claims accept the matching EVV data.

Pros of alternate EVV:

• If your agency already has a robust agency management system or EMR with EVV features, you avoid duplicating systems.

• Potentially more control, customization, better integration with internal scheduling, payroll, or other workflows.

• May suit larger agencies or those with unique workflows.

Cons / Risks:

• Setup requires technical expertise, configuration, data mapping, EDI interface.

• Mistakes in mapping or data errors can lead to rejected EVV or denied claims.

• More administrative overhead to maintain accuracy, data integrity, audits, compliance.

Part 5: Recent EVV / CHC Compliance Updates & What They Mean for Agencies

It’s important to stay current, EVV and CHC compliance requirements evolve. Here are some recent developments and what they mean for agencies.

Increased EVV Compliance Thresholds

Starting January 1, 2025, many MCOs and the state have raised EVV compliance expectations: agencies must ensure a high percentage of visits are auto-verified without manual edits. Reports suggest targets like 85% EVV match rate for PCS and HHCS visits as an industry standard.

Agencies failing to meet compliance thresholds may face denial of claims, contract penalties, or increased scrutiny.

EVV Requirement Now Applies to Home Health Care Services (HHCS)

Originally EVV in Pennsylvania applied to Personal Care Services (PCS) only. But as of January 1, 2024, EVV requirements formally expanded to Home Health Care Services (HHCS) for Medicaid-funded in-home skilled or home health aide services.

For agencies offering home health aide or similar services under CHC, this means EVV compliance is mandatory for those services as well.

EVV Indicators Must Be Selected in Enrollment/Claims System

As part of enrolling or revalidating your Medicaid/CHC provider profile (often via state system like PROMISe or during MCO revalidation), you must affirm that you provide EVV‑subject services. A specific “EVV indicator” must be selected; omission can lead to claims rejections.

Integrated EVV + Billing + Authorizations Platforms Are the Norm

Because of EVV’s complexity and the need for compliance, many MCOs and the state encourage or require use of unified platforms (e.g., HHAeXchange) that integrate care plan authorizations, scheduling, EVV, and claims billing. This helps reduce errors, improve compliance, and simplify workflows.

Part 6: Practical Advice & Best Practices for Agencies

Based on the regulatory and technical environment, here are recommended best practices for home care agencies in Pennsylvania to ensure smooth CHC and EVV compliance:

1. Start EVV conversations early, before enrolling with an MCO, consider whether to use the MCO’s EVV system (easiest) or integrate your own EVV. Factor in technical capacity, staffing, costs, and training.

2. Use the MCO’s EVV system if new or small, for most small to medium-sized agencies, using HHAeXchange or other MCO‑provided EVV is simpler, affordable (often free), and reduces compliance risk.

3. If using own EVV, work with experienced vendor or consultant, ensure your system is certified/approved, can interface with PA‑DHS Aggregator, and correctly maps service codes, contract types, member and caregiver data.

4. Train caregivers and office staff thoroughly, ensure they understand how to clock-in/clock-out properly, provide accurate location and time data, and what to do if there’s an issue (internet outage, late start, etc.).

5. Monitor EVV compliance metrics regularly, track auto-verified visits vs manual edits, missing data, rejection rates. Fix issues early before claims are denied.

6. Maintain clean and accurate client and caregiver data, incorrect Medicaid IDs, names, or addresses often cause aggregator rejections. Always double-check data.

7. Stay current on regulatory updates from DHS and MCOs, EVV requirements evolve. Make sure your agency revalidates enrollment, updates software, and meets new thresholds (e.g., 85% auto‑verified visits).

8. Integrate EVV with billing and scheduling to streamline operations, a combined workflow (scheduling → EVV → billing) reduces paper, manual work, and risk of missed visits or unbilled services.

9. Have fallback protocols for exceptions, emergencies, missed visits, client cancellations, ensure your agency knows how to document missed or modified visits with correct Reason Codes as required by EVV Aggregator.

10. Maintain documentation for audits, EVV data, care plans, authorizations, timesheets, missed‑visit logs, and communication history should be accessible in case of DHS or MCO audit or review.

Part 7: Common Challenges & How to Overcome Them

Even with preparation, agencies often face hurdles when implementing CHC/EVV. Here are some common issues and solutions:

Challenge: Caregiver Resistance to Technology (Mobile App / Telephony)

Solution: Provide simple training sessions, practice calls with caregivers; optionally allow telephony clock‑in for those without smartphones; distribute easy-to-follow instructions; offer incentives for timely clock-ins.

Challenge: Data Entry Errors, Incorrect Medicaid IDs, Misspelled Names, Wrong Codes

Solution: Implement a data‑verification protocol: before uploading or entering new client or caregiver, double-check key fields; assign a dedicated admin to handle data entry and verification.

Challenge: Low Auto‑Verification Rate, high number of manual edits or missing visits

Solution: Monitor compliance metrics weekly; analyze root causes (late caregiver call-in, phone/connection issues, scheduling mismatch); retrain staff; if using alternate EVV, ensure the interface with aggregator is properly configured.

Challenge: Denied Claims Because EVV Not Matched or Missing EVV Indicator

Solution: During provider enrollment or revalidation, ensure EVV indicator is selected; check each claim against EVV records before submission; resolve mismatches promptly; maintain communication with MCO provider support.

Challenge: Managing Multiple MCOs with Different Rules

Solution: Use a unified EVV and billing platform (like HHAeXchange) that supports all contracted MCOs to simplify workflows; maintain separate tracking for each MCO’s authorizations and billing rules.

Conclusion

For a home care agency in Pennsylvania, enrolling in CHC and complying with EVV requirements is no longer optional, it is essential. These systems are designed to ensure transparency, accountability, and proper reimbursement, but they bring technical and operational demands.

By following the steps outlined in this blog, choosing the right EVV system approach, and adhering to best practices, training staff, tracking compliance, maintaining data integrity, your agency can meet CHC and EVV requirements successfully.

Doing so not only ensures compliance and payment but also enhances the quality, reliability, and credibility of your services. Agencies that master CHC enrollment and EVV implementation are better positioned to thrive long-term in Pennsylvania’s home care landscape.