In Colorado, home care is about more than just great clinical work—it’s about staying on top of the paperwork. Since 2020, Electronic Visit Verification (EVV) has become the backbone of how we get paid by Medicaid. For us as agency owners, EVV isn’t a ‘new’ hurdle anymore; it’s a daily part of our business that keeps our finances healthy.
As HCPF tightens its rules, staying compliant is more important than ever to protect your revenue. Whether you’re providing Personal Care (PCS) or Home Health (HHCS), these eight tips will help you simplify your workflow and keep your billing on track.
1. Master the Colorado Hybrid Implementation Model
Colorado utilizes a hybrid model for EVV, offering providers a choice between the state-funded Sandata solution or a third-party vendor. While the state solution is free, many growing agencies find that “Provider Choice” systems offer better integration with their existing workflows.
Understanding this choice is the first step toward long-term efficiency. If you choose a third-party platform, ensure it is fully compatible with the state’s data aggregator. A high-quality Home care software solution can bridge this gap, allowing you to manage schedules and compliance in one unified interface rather than toggling between disconnected portals.
2. Capture the Six Essential Data Points Every Time
To avoid claim denials, every visit must capture six specific data elements mandated by the 21st Century Cures Act. In Colorado, these include the type of service performed, the individual receiving the service, the date, the location, the caregiver providing the service, and the exact start and end times.
Missing even one of these points can flag a visit as non-compliant. By utilizing an Advance EHR system, you can automate the collection of these data points. When caregivers clock in via a mobile app, the system automatically timestamps and geo-locates the visit, significantly reducing the risk of human error that leads to payment delays.
3. Minimize Manual Visit Entries and Modifications
HCPF monitors the volume of manual entries and visits modifications closely. While Colorado currently allows for manual entries when technology fails, repeatedly exceeding established thresholds can trigger an audit. Manual entries are often seen as “high-risk” because they lack the real-time verification that GPS or telephony provides.
Aim for a “Mobile-First” culture within your staff. Encourage caregivers to use the mobile application as their primary method of verification. When a manual edit is truly necessary, ensure your team documents the specific reason immediately to remain HIPAA Compliant while providing a clear audit trail for state reviewers.
4. Stay Updated on New Procedure Codes
The Colorado EVV environment is constantly evolving. Recent updates have introduced new procedure codes for Community First Choice (CFC) services and modified the requirements for Behavioral Therapy. To ensure seamless claim adjudication and avoid denials, it is critical to maintain strict synchronization between your system’s service codes and the latest HCPF Program Manual. Precise alignment with these regulatory shifts is the only way to guarantee clean billing and sustained compliance.
If your software isn’t updated to reflect these new codes, your EVV data won’t match your claims, leading to immediate “Record Not Found” errors. A reliable platform like myEZcare ensures that your system stays aligned with the latest state-specific billing inclusions and code changes.
5. Implement a Robust Caregiver Training Program
Your EVV system is only as effective as the caregivers who use it. In Colorado, many claim denials stem from caregivers selecting the wrong service code during a visit or failing to “clock out” properly when moving between different service types (such as transitioning from Personal Care to Homemaker services).
Develop a continuous education program that includes hands-on mobile app training. Show your staff how their accuracy directly impacts the agency’s ability to pay them on time. When caregivers understand the “why” behind the technology, they are much more likely to maintain the data integrity your agency requires.
6. Leverage Real-Time Monitoring and Alerts
Waiting until the end of the week to check for missing EVV records is a recipe for administrative burnout. The most successful Colorado providers use real-time dashboards to monitor caregiver activity.
By utilizing integrated EVV tools with live alerts, office staff can see instantly if a caregiver is late for a visit or has forgotten to clock out. This proactive approach allows you to correct errors while the details are still fresh in the caregiver’s mind, preventing the “Friday afternoon scramble” to fix visit records before payroll and billing deadlines.
7. Understand the Live-In Caregiver Exclusions
Colorado provides specific exemptions for live-in caregivers who meet HCPF requirements. However, these exemptions are not automatic; they require a formal “Attestation of Exemption” form and supporting documentation.
If your agency utilizes live-in staff, ensure your records are up to date and that your EVV system is configured to handle these visits correctly. Failing to properly document an exemption can result in unnecessary claim denials for services that the state would otherwise consider valid.
8. Perform Regular Internal Audits
Don’t wait for a state auditor to find gaps in your documentation. Schedule monthly internal reviews of your “EVV Compliance Reports,” which are accessible via the HCPF portal. Look for patterns in denied visits or frequent modifications by specific staff members.
Regular self-auditing allows you to identify training gaps and technical issues before they become systemic problems. It also demonstrates a “Good Faith Effort” toward compliance, which can be a vital defense if your agency ever faces a formal state review.
Frequently Asked Questions (FAQ)
What services in Colorado require EVV?
In Colorado, EVV is required for a wide range of services, including Personal Care, Homemaker services, Home Health (RN, LPN, CNA), Physical Therapy, Occupational Therapy, and Behavioral Therapies provided in the home. You should always refer to the latest HCPF Program Manual for the most current list of included service codes.
Can I change my EVV vendor after I have already started?
Yes. Colorado allows “Provider Choice,” meaning you can switch to a third-party vendor at any time. However, you must ensure that your new vendor has successfully completed the interface testing with Sandata (the state aggregator) to ensure your data continues to flow to HCPF without interruption.
Does Colorado require GPS tracking during the entire visit?
No. Colorado’s EVV policy specifically prohibits continuous GPS tracking or “geo-fencing” that monitors a caregiver’s movement throughout the day. The GPS is only used to verify the location at the specific moments of “clock-in” and “clock-out.”
What happens if a claim is submitted without matching EVV data?
Beginning in 2022, HCPF implemented a pre-payment review. If a claim is submitted and a corresponding EVV record is not found in the aggregator, the claim will be denied or suspended. This makes real-time data transmission essential for your agency’s cash flow.
Are there biometric requirements for Colorado EVV?
No. Unlike some other states, Colorado does not require biometric verification (such as fingerprints or facial recognition) or voice recording for EVV compliance. The system relies on digital timestamps and GPS location from mobile devices or telephony.
