Massachusetts EVV Heading Into 2027: Verified Visits to Paid Claims

For Massachusetts home care providers, Electronic Visit Verification (EVV) is becoming more closely connected to reimbursement. MassHealth is moving from compliance monitoring toward claims-based enforcement – placing greater importance on accurate, verified visit data.

This means it’s more important than ever to ensure your processes set your agency up for success.

As 2027 approaches, here’s what Massachusetts agencies need to know:

What’s changing in Massachusetts?

MassHealth launched its agency-based EVV system on September 30, 2024, with Sandata serving as the state-sponsored system and central data aggregator.

Under Massachusetts’ open EVV model, agencies can use Sandata or a compatible, registered third-party solution that sends the required information to the aggregator.

MassHealth’s compliance rollout has three stages: registration, visit monitoring, and claims enforcement.

Since October 2025, affected fee-for-service providers have received soft edits: informational messages on remittance advice when a claim doesn’t match an EVV record. These alerts don’t themselves prevent payment.

The next step involves hard edits, under which claims without matching verified visits can be denied.

MassHealth’s July 2026 training stated that the implementation date is still to be confirmed, so agencies should continue checking official guidance for updates.

These claims-edit arrangements concern fee-for-service Home Health, Group Adult Foster Care (GAFC), and Acquired Brain Injury/Moving Forward Plan (ABI/MFP) waiver services. Other programs and payer arrangements may have different requirements.

What needs to match?

For affected claims, MassHealth checks the submitted billing information against a verified EVV record, including:

1. Provider and member IDs: the billing provider and Medicaid member must match the visit record.
2. Service codes: the billed service must align with the service recorded through EVV.
3. Dates of service: the claim and visit must refer to the same date.
4. Units: billed units must not exceed the units supported by the verified visit.
5. Verification and timing: the visit must have “Verified” status and reach Sandata before the claim is submitted.

For instance: imagine a caregiver completes a visit correctly, but the service code recorded through EVV differs from the code on the claim.

The care happened, the visit was recorded – but the information doesn’t match. Under hard edits, that discrepancy could affect payment.

What happens when a claim doesn’t match?

Soft-edit messages on remittance advice help agencies identify discrepancies while claims continue through payment processing.

For hard edits, MassHealth has outlined a 30-day claims-suspension process. Under this (planned) process, an unmatched claim would be held while the agency corrects the visit record or claim. If the mismatch remains unresolved, the claim may be denied.

The practical lesson here is this: regularly reviewing records and investigating mismatches helps agencies prepare for enforcement and reduce avoidable reimbursement delays.

Another MA EVV number worth watching: 50%

Alongside claims matching, MassHealth measures how often visits are verified without manual corrections. Its April 1, 2026 compliance checkpoint requires applicable providers to achieve at least 50% automatically verified visits during the visit-monitoring phase, until claims edits are implemented.

An automatically verified visit is one where the required information is captured electronically without manual entry or correction after the fact.

So there’s an important distinction here: a manually corrected visit can still be verified and support a claim, but it doesn’t count toward the auto-verification percentage.

How can Massachusetts agencies prepare for 2027?

• Track verification performance: review auto-verified visits and recurring manual corrections.
• Check claims alignment: confirm that your provider IDs, member details, service codes, dates, and units all agree.
• Confirm transmission and status: make sure EVV records reach the state aggregator and are marked “Verified” before claims are submitted.
• Review claims-matching results: investigate informational codes on remittance advice and address recurring discrepancies.
• Support frontline teams: reinforce accurate clock-ins, clock-outs, and visit documentation.

Aaniie + Sandata: Keep EVV connected

Massachusetts’ open EVV model gives agencies the flexibility to choose technology that supports their wider operations. Aaniie Care’s all-in-one home care software integrates with Sandata for Massachusetts EVV, allowing agencies to capture visit information through Aaniie and transmit the required data to the state aggregator.

Because EVV is embedded within the Aaniie Care platform, agencies can keep it connected with GPS-enabled mobile clock-ins, offline EVV, scheduling, care documentation, billing, and KPI dashboard.

Aaniie Care’s unique Sandata EVV Verification Method KPI adds a unique layer of visibility, showing how visits are verified over time and highlighting manually corrected visits. This helps agencies monitor manual adjustments, spot recurring patterns, and identify opportunities to improve auto-verification performance — particularly valuable given Massachusetts’ 50% compliance checkpoint.

Discover a more dependable path from visit to payment

In Massachusetts, the direction of travel is clear: the quality of EVV information matters well beyond the moment a caregiver clocks out. Accurate visit capture, fewer unnecessary corrections, timely transmission, and reliable claims matching all contribute to a stronger foundation for care delivery and reimbursement.

That’s why, with Aaniie Care, EVV is part of a more connected operation – giving agencies like yours greater visibility, less administrative friction, and more time to focus on the people who matter most.

When every visit counts, make sure the information behind it does, too.