If you run a Medicaid-funded agency in Texas, you already know the feeling: the visit happened, the caregiver did good work, the family is happy, and the claim still comes back denied because something in the EVV record didn’t line up. Electronic visit verification is one of those rules that looks simple on paper and turns into a daily operational job in practice.
The short answer: in Texas, every EVV-required visit has to reach the state’s EVV Aggregator as an accepted visit, and your claim has to match it on a handful of exact data points, or the payer denies it. Most denials come from a few fixable habits. Here are the 2026 rules, what changed recently, and how I would set an agency up.
What EVV is and who it applies to
EVV is a federal requirement that Texas implements through its own policy. The 21st Century Cures Act (section 12006) added section 1903(l) to the Social Security Act, which requires states to use electronic visit verification for Medicaid personal care services and home health care services. The law defines an EVV system as one that electronically verifies six things: the type of service performed, the individual receiving the service, the date, the location of service delivery, the individual providing the service, and the time the service begins and ends. You can read that definition in 42 U.S.C. §1396b(l).
Texas was ahead of the mandate for some services: HHSC says certain “state-required” personal care services used EVV in 2016 or earlier.
Which Texas programs and services require EVV
HHSC lists two main dates on its EVV page:
- January 1, 2021: EVV required for Medicaid personal care services under the Cures Act.
- January 1, 2024: EVV required for Medicaid home health care services (HHSC calls these “Cures Act HHCS”).
Personal care includes services such as Community First Choice PAS and HAB, Primary Home Care and Community Attendant Services. On the home health side, the April 2026 HHSC list covers in-home skilled nursing visits and occupational and physical therapy provided in the home under Traditional Medicaid fee-for-service, STAR and STAR+PLUS, plus nursing and therapy services in waivers such as CLASS, DBMD, HCS, TxHmL and STAR+PLUS HCBS, and RN delegation and supervision in STAR Kids and STAR Health. Some settings are excluded, such as assisted living in several programs.
Two details catch agencies out. HHSC states that live-in caregivers are not exempt from EVV in Texas. And the list changes, so work from the current HHSC documents and EVV bill codes tables, not a blog post, including this one.
The state system, proprietary systems and the Aggregator
The state-provided EVV system: HHAeXchange
Since October 1, 2023, the single state-provided EVV system in Texas has been HHAeXchange. It replaced the two earlier vendors (DataLogic/Vesta and First Data/AuthentiCare). The HHAeXchange Texas page says its portal is available at no cost to program providers, FMSAs and CDS employers.
Proprietary systems
An agency can instead use an EVV proprietary system, meaning software other than the state system, but only with HHSC approval. The provider submits a request, TMHP runs an Operational Readiness Review, and an approved provider becomes a Proprietary System Operator (PSO). HHSC does not directly reimburse the cost of a proprietary system, though the handbook says related costs may be reported through Medicaid cost reporting.
The EVV Aggregator and EVV Portal
Whichever system you use, visits flow into the EVV Aggregator, which HHSC describes as the centralized database that collects, validates and stores statewide EVV visit data. TMHP, the state’s Medicaid claims administrator, manages the Aggregator, the claims matching process and the EVV Portal, where you can search visits and view claim match results.
Approved clock-in and clock-out methods
The EVV Policy Handbook lists three HHSC-approved methods:
- Mobile method: an app on the caregiver’s device using GPS. The allowed geo-perimeter must be within 250 to 1,320 feet of the member’s home. It is the only method allowed when services are delivered in the community or out of state, and the caregiver may not use the member’s personal phone or tablet.
- Home phone landline: a call from the member’s landline. Cell phones and cellular-enabled devices such as tablets and smart watches are not allowed.
- Alternative device: a device that must always remain in the member’s home. Codes from alternative devices supplied through the state system expire seven days from the date of the visit.
Alternative devices are being phased down. The handbook sets a usage limit as a share of transactions: 75% from September 1, 2025 to August 31, 2026, then 50% from September 1, 2026 to August 31, 2027, 25% the year after, and 5% from September 1, 2028 onward. If you lean on alternative devices, the 50% limit applies now, and that deserves a plan.
When no method works, staff can record a manual visit, but manual visits count against your usage score.
How claims matching works (the “hard edit”)
People often call this the EVV hard edit. The handbook calls it claims matching, and the rule is strict. Per section 13000, EVV Claims, every claim for an EVV-required service must match an accepted visit in the Aggregator before the payer reimburses it. The Aggregator compares:
- Medicaid ID
- Date of service to EVV visit date
- Provider identifier (NPI or API) and Texas EVV service provider ID
- HCPCS code and modifiers
- Billed units to billable units
If any of these don’t match, the Aggregator returns an unsuccessful match result code and the payer denies the claim. Result code EVV01 means a successful match, EVV02 to EVV06 describe specific mismatches, and EVV07 and EVV08 are bypass codes used in situations such as disasters or system issues. The handbook also says to submit claims only after all visits on the claim are completed and accepted.
Units are a quiet source of trouble. The EVV system rounds each visit’s total duration to the quarter hour (eight minutes or more rounds up), and bill hours come from actual time worked. Bill scheduled hours and you will see unit mismatches.
What changed in 2025 and 2026
HHSC published three handbook revisions in this period:
- Revision 25-1, effective March 12, 2025: mostly text and link updates.
- Revision 25-2, effective September 2, 2025: reorganized stakeholder sections, added a section on proprietary system vendors, and updated training, compliance review and visit maintenance text.
- Revision 26-1, effective January 30, 2026: updated setup, training and manual visit sections, and added sections on alternative device compliance reviews.
The change I would flag for any administrator: the compliance review section now says “HHSC no longer implements compliance grace periods, effective Jan. 30, 2026.” If your team remembers a softer era with grace periods, that is over.
Compliance reviews, usage scores and training
The EVV Usage Score
Payers run EVV compliance reviews quarterly by state fiscal year quarter. The main one is the EVV Usage Score, and the minimum is 80% each quarter. For program providers, the score combines two parts: a manual visit score (weighted 60%) based on how many accepted visits were captured electronically rather than entered manually, and a rejected visit score (weighted 40%) based on how many exported visits were not rejected.
Payers also run landline phone verification reviews and alternative device usage reviews. Consequences escalate within a 24-month period: a first occurrence requires additional training within 20 business days, a second requires a corrective action plan, and repeated failures can lead to proposed contract termination. Payers can also temporarily withhold Medicaid payments when required actions aren’t completed.
Common causes of EVV denials, and how to reduce them
Most problems fall into a few buckets.
| Cause | What to do |
|---|---|
| Missed clock-ins or clock-outs | Daily exception review, reminders to caregivers, and a quick path to fix the visit before billing. |
| Too many manual visits | Find the caregivers and clients driving them, and fix the device, app or phone issue rather than correcting by hand forever. |
| Units billed from the schedule | Bill from verified bill hours in the EVV system, never from scheduled hours. |
| Wrong HCPCS code or modifier | Keep service setup aligned with the current EVV bill codes tables and each authorization. |
| Member or provider ID mismatches | Validate Medicaid IDs, NPI and EVV service provider IDs at intake and when contracts change. |
| Billing before visits are accepted | Check acceptance in the Aggregator or EVV Portal before submitting claims. |
| Visit maintenance left too late | Work exceptions weekly. Visit maintenance must be done within 95 calendar days, after which the visit locks. |
A few rules about visit maintenance are worth training on explicitly. You cannot change the actual service date, the actual clock-in and clock-out times, actual hours worked or GPS coordinates. You pick a reason code for each change, and free text is required for code 210 (emergency) and code 600 (other). Unlocking a visit after 95 days requires payer approval and evidence that you raised the error in time.
Training requirements
The handbook requires training before anyone uses the state system or a proprietary system, and yearly after that. Program provider staff must complete EVV system training, EVV Portal training and EVV Policy training. Caregivers (service providers) must complete training on clock-in and clock-out methods. Put these on your onboarding checklist and annual compliance calendar.
How agency software can integrate with EVV
You have two realistic routes. The first is to use HHAeXchange as your EVV system and connect your other tools to it. HHAeXchange states that third-party systems such as payroll or EHR software can exchange data with the state system through APIs, covering service providers, members, schedules, visits and authorizations. The second is to become a PSO with your own approved system, which means HHSC approval, TMHP’s readiness review and ongoing responsibility for getting your visits accepted.
For most agencies, the first route is simpler. The value of your own software is in what surrounds EVV: authorizations, schedules, billing and payroll tied to the same verified visit. I explain how I evaluate that stack in my guide to home healthcare agency software, and whether a record system or a CRM should sit at the center in home health CRM vs EMR. If you are weighing a custom layer against a packaged product, custom CRM vs off-the-shelf covers the trade-offs. Exception review and caregiver reminders are also good candidates for automation, as I discuss in where AI actually helps in home healthcare operations.
Frequently asked questions
When did EVV become required for home health care services in Texas?
HHSC requires EVV for Medicaid home health care services from January 1, 2024. It covers services such as in-home skilled nursing and in-home occupational and physical therapy across Traditional Medicaid, STAR, STAR+PLUS and several waivers. Personal care services have required EVV under the Cures Act since January 1, 2021, and some state-required services used EVV earlier.
Is HHAeXchange required for Texas EVV?
No. HHAeXchange is the state-provided EVV system and has been since October 1, 2023, and its portal is free for providers. Agencies can instead use an HHSC-approved proprietary system, which requires an approval process and a TMHP Operational Readiness Review. Either way, visits must be accepted by the EVV Aggregator before claims can match.
What causes an EVV claim to be denied in Texas?
A claim is denied when it doesn’t match an accepted visit in the EVV Aggregator on Medicaid ID, date of service, provider identifiers, HCPCS code, modifiers or units. Common root causes are missed clock-ins, billing scheduled rather than verified hours, wrong codes or modifiers, ID mismatches, and submitting claims before visits are accepted.
What clock-in methods are allowed for EVV in Texas?
HHSC approves three methods: the mobile method (a GPS-based app), the member’s home phone landline, and an alternative device kept in the member’s home. Cell phones can’t be used as the landline method, caregivers can’t use the member’s own phone for the mobile method, and alternative device use is capped at 50% of transactions from September 1, 2026.
Are there EVV compliance grace periods in 2026?
No. The EVV Policy Handbook states that HHSC no longer implements compliance grace periods, effective January 30, 2026. Payers review EVV usage quarterly against an 80% minimum score, and repeated failures within 24 months escalate from training to corrective action plans and possible contract action. Check the current handbook for any later changes.
Want a second pair of eyes on your EVV process?
I’m a Solutions Architect at Lonestar Home Healthcare, and before that I helped build Pinn.Care, an ERP for home healthcare agencies, at Pinn.Media. If you want someone to look at where your EVV denials are coming from, or how your systems should connect to HHAeXchange and billing, get in touch and I’ll give you an honest read.
