Pennsylvania EVV Compliance

Pennsylvania Uses Sandata for Fee-for-Service
and HHAeXchange for Some MCOs. Verify Per Payer.

Pennsylvania's primary EVV aggregator is Sandata for fee-for-service Medicaid billing. But HealthChoices managed care clients may route through HHAeXchange depending on the specific MCO. The right system for each client depends on their coverage — verify with each contracted payer. CareBravo manages both as delivered operational work.

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Pennsylvania EVV — Quick Reference

What Pennsylvania Requires by Payer Type

Payer / Pathway
EVV System
Notes
Medicaid Fee-for-Service
Sandata (state aggregator)
DHS-designated aggregator for direct Medicaid billing outside managed care
HealthChoices MCOs (managed care)
HHAeXchange (some MCOs) — verify per plan
Not all HealthChoices MCOs require HHAeXchange — confirm with each contracted plan
State Agency
PA DHS — Pennsylvania Department of Human Services
Oversees EVV framework; individual MCOs set their own requirements within the state framework
Key Programs
HealthChoices (managed care), OBRA Waiver, Aging Waiver, COMMCARE Waiver
EVV system requirements vary by program and payer — verify with DHS and each MCO
EVV Model
Open
Agency-choice capture method; aggregator determined by payer

Pennsylvania's payer-split EVV structure means the correct system for each client depends on who covers them. A fee-for-service client uses Sandata. A HealthChoices member through a specific MCO may use HHAeXchange. Verify with each contracted payer — do not assume Sandata covers all clients or that HHAeXchange covers all managed care members.

Pennsylvania's HealthChoices Complexity

Managed Care in Pennsylvania Adds a Verification Step

Pennsylvania's HealthChoices program enrolls most Medicaid-eligible individuals in managed care. Home care services for HealthChoices members are billed through the member's specific MCO — and each MCO may have different EVV requirements. Some require HHAeXchange. Others may accept Sandata submissions. A few may have different arrangements entirely.

The practical requirement for Pennsylvania agencies is to verify EVV requirements with each HealthChoices MCO at the time of contracting. Your provider agreement or the MCO's current provider manual should specify EVV requirements. Agencies that assume Sandata covers all their Pennsylvania clients — because it covers their fee-for-service clients — will discover the error at billing time when managed care claims lack the expected EVV records.

CareBravo manages EVV compliance across both Sandata and HHAeXchange for Pennsylvania agencies, tracking the correct system by client based on their coverage, and delivering billing-ready outputs for every payer without requiring the agency to maintain separate manual workflows.

The Real Cost

Wrong-System Submissions Don't Show Up Until Billing

An EVV record submitted to Sandata for a client whose MCO requires HHAeXchange doesn't generate a visible error at the time of submission. It generates a denial at billing time — when the MCO's claims system can't find a matching HHAeXchange record for the visit. By then, the visits may span weeks. CareBravo tracks the correct EVV system per client from the start, so wrong-system submissions don't accumulate into a billing cycle problem.

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Questions

Pennsylvania EVV — Common Questions

Pennsylvania uses Sandata as the state-designated EVV aggregator for fee-for-service Medicaid billing. For HealthChoices managed care clients, the EVV requirement depends on the specific MCO — some require HHAeXchange. Verify with each MCO you are contracted with and review your provider agreements for the specific EVV requirements that apply to each client segment.

Pennsylvania's OBRA Waiver provides HCBS to individuals with physical disabilities. Services delivered in the home under OBRA are subject to EVV requirements. The specific EVV system depends on whether the client is in fee-for-service or managed care — verify with DHS and the relevant payer for OBRA waiver clients. The Aging Waiver and COMMCARE Waiver follow the same structure.

Yes. Pennsylvania's Open model allows agencies to use any compliant capture tool as long as data flows to the correct aggregator — Sandata for fee-for-service, or the MCO-specified system for managed care clients. Confirm that your capture tool has verified integrations with both Sandata and HHAeXchange if you bill across both payer types.

Yes. CareBravo manages EVV compliance across Sandata and HHAeXchange — tracking the correct system by client based on their coverage, resolving exceptions in both systems daily, and delivering billing-ready outputs for all payers as completed operational work.

Pennsylvania EVV Compliance — Both Systems, Delivered

CareBravo manages Sandata and HHAeXchange exception resolution and Pennsylvania Medicaid billing readiness — tracking the right system per client, delivering billing-ready outputs for every payer as completed operational work.

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