How to Meet the New 85% EVV Compliance Standard in 2025

Medicaid providers in home care are facing a non-negotiable shift. Beginning in 2025, states such as Pennsylvania, New Jersey, and North Carolina will start strictly enforcing the 85% EVV compliance rule—meaning most visits must be auto-verified to avoid penalties. That means 85% of visits must be automatically verified in real-time, with no late entries or manual edits.

If you fail to meet the benchmark, expect claim denials, audits, corrective action plans, or worse—Medicaid disenrollment. Let's examine what providers need to do right now in order to remain competitive.

How to Achieve the 85% EVV Auto Verification Rate?

To stay compliant, your team needs to consistently reach at least an 85% auto verification rate. That is a daily requirement, not a quarterly goal. Every visit should be verified through approved methods like GPS-enabled mobile apps or landlines. Avoid VoIP check-ins—they’re not accepted in states like Pennsylvania, North Carolina, and others.

Don’t ignore failed verifications. Investigate every case—whether it's a missed check-in, GPS issue, or manual edit.Address the cause as well as the symptom.

Some states are raising the bar. PA, FL, and NM officially demand 85% or higher. So here’s the thing: if you’re not tracking your EVV compliance daily, you’re already behind. Set internal expectations, coach your staff, and make it part of your billing workflow. Your EVV verification rate is more than a number—it protects your reimbursements and reputation.

Key Steps to Meet the 85% EVV Compliance Requirement

Fortify Your EVV Tech Stack & Integrations

Your EVV technology should power compliance, not slow it down. 

Use state-approved EVV platforms that automatically capture all six Medicaid-required data points—time, service, caregiver, recipient, location, and visit type. Anything less is noncompliant.

To cut down on errors and do away with manual entry, integrate your EVV with scheduling, payroll, and EHR systems. Don’t trust assumptions—test your full workflow regularly from check-in to state aggregator to claims submission. 

If your EVV system can’t keep up, it’s putting your Medicaid reimbursements at risk.

A strong, integrated EVV setup is the backbone of consistent EVV compliance and successful audits.

Embed Rigorous Training, Accountability & Governance

Even the most advanced EVV system can't deliver compliance if your team isn’t trained to use it right. 

Schedule quarterly hands-on EVV training for both field and office staff. Clearly define what qualifies for manual edits—only documented tech failures should pass.

Assign dedicated EVV compliance champions to track metrics, flag patterns, and guide daily corrections. This level of accountability drives results. 

In Pennsylvania, providers who ran regular EVV drills saw manual edit rates drop below 15%. 

The bottom line: strong tech needs strong people behind it to meet and sustain EVV compliance standards.

Operationalize Daily Monitoring & RMEs

Real-time data means real-time response.

• Use dashboards and alerts to track check-ins and late/missed entries

• Run weekly exception reports to spot high-risk trends

• Review patterns monthly to prevent audit triggers

North Carolina saw only 28–31% of visits without manual edits in 2023—a clear monitoring gap.

Limit Manual Edits to Less Than 15%

An excessive number of manual modifications may result in audits or remedial action. States like New Jersey and Pennsylvania are flagging providers with over 15% manually edited EVV records. To stay compliant, set strict internal rules that define when manual corrections are allowed—only for valid, documented reasons. Require supervisor approval for every change to ensure accountability. 

To stay compliant:

• Define clear internal rules for manual corrections

• Require supervisor approval for any change

• Re-train staff with repeated errors

Prepare a Rapid Real-Time Response Workflow

• Leaving EVV issues unresolved can quickly lead to denied claims and delayed or withheld payments—it adds up faster than most agencies realize.

• Set a same-day resolution goal for all EVV errors—missed check-ins, GPS failures, or manual edits. 

• Create clear escalation paths for repeated problems, so supervisors can step in quickly. 

• Always log corrective actions, including who fixed it, when, and the outcome. This documentation supports your compliance during audits.

•  In Hawaii, agencies with excessive manual edits can see up to 15% of payments withheld—released only after resolution. Fast action isn’t optional. It's a core part of maintaining strong EVV compliance and protecting revenue.

Build Audit-Ready Documentation Systems

• Documentation is the backbone of EVV compliance. 

• Every visit must have a complete log—timestamps, GPS location, caregiver name, and service details. 

• Keep clear audit trails showing who made changes, when, and the reason behind each edit. 

• Save all communications tied to missed visits or corrections, including texts, emails, or internal notes. 

• This protects your agency during audits and payment reviews. 

• States like Kansas, Ohio, and New Mexico are ramping up EVV audits, flagging repeat offenders for poor documentation.If your records aren’t airtight, your claims and Medicaid standing are at risk.

Navigate State-Specific EVV Rubrics

Your state’s rules are unique—know them.

State	85% Rule Effective	Manual Edit Cap	Penalties
Pennsylvania	Jan 1, 2025	≤15% per FFS quarter	Contract risk after 3 months underperformance
New Jersey	Jan 1, 2025	≤15%	Denials and audits triggered on excessive edits
North Carolina	Oct 1, 2025	≤15%	Real-time claim denials for non-EVV visits
Ohio/NY/FL	Varies	Often ≤10%	Payment holds and escalated audits

Most states aim for 85–90% real-time verification by 2025.

Collaborate with State Agencies & Vendors

You’re not alone—use the system.

• Attend state EVV webinars for live updates

• Use vendor and aggregator support to solve compliance bugs

• Join regional EVV working groups to learn what works

225+ agencies joined Pennsylvania’s 2024 EVV Collaborative—those who did saw stronger readiness.

EVV Compliance Comparison Table

Feature	Compliant Agency	Non-Compliant Agency
Real-time auto-verification	85% or more of visits auto-verified	Less than 85% rely on manual edits
Manual correction threshold	< 15% of all records per quarter	>15%, triggering corrective action plans
Staff training frequency	Ongoing every quarter	Infrequent or one-time training
Use of EVV dashboards	Real-time alerts and weekly reviews	Monthly or no active tracking
Claims approval rate	High, minimal denials	Delays, denials, rejected submissions
Audit readiness	Fully documented visits and corrections	Disorganized or incomplete visit records

Deploy Technology for Compliance & Scale

• Scaling your agency without automation leads to costly mistakes. 

• Use EVV analytics tools to spot compliance issues early—before they affect claims. 

• Enable AI-driven alerts to catch real-time errors like missed check-ins or invalid edits.

• Invest in or develop EVV system integrations using APIs to connect with payroll, scheduling, and EHR platforms. This removes duplication and reduces manual entry risks. 

• Agencies that integrated their EVV with state aggregators saw a 30% reduction in audit rejections. 

• The right tech isn’t just for efficiency—it’s key to maintaining EVV compliance as your operations grow.

FAQ

1.What is EVV compliance?

EVV compliance means hitting the 85% auto-verification rate using real-time methods like GPS or landline—no late entries, VoIP logs, or excessive manual edits allowed.

2.What counts as an auto-verified EVV visit?

A visit logged in real-time via GPS app or registered landline, capturing all six data points. Most states do not accept manual or VoIP logs.

3.How can we reliably monitor EVV compliance?

Check your state aggregator dashboard daily, use your EVV vendor’s built-in reports, and run weekly audits to track missed check-ins and exceptions before they impact claims.

Conclusion

Meeting the 85% EVV compliance threshold isn't optional—it’s essential. Whether you're learning what is EVV in home care or using electronic visit verification Pennsylvania requires, success comes from daily effort. Automate where you can, train your staff, and keep your EVV system for home care working smarter—not harder—to stay ahead.