Texas EVV Exception Management: Correction Workflows and Documentation Requirements

You can have a fully trained caregiver, a signed care plan, and a completed visit — and still lose the claim if the EVV data doesn't hold up. That's the reality of electronic visit verification in Texas: the technology captures the visit, but a person has to make sure the data is correct. When it isn't, you have an exception. When exceptions aren't resolved properly, you have denied claims, audit exposure, and eventually MCO scrutiny.

This guide covers what each exception type means, how Sandata and HHAeXchange categorize them, what the correction process looks like in each system, and what documentation you need to keep your agency audit-ready.

An EVV exception is any visit record where the required verification data is missing, incomplete, or doesn't match what was authorized. Texas requires six data points for every Medicaid-funded personal care visit:

1. The identity of the person who received the service
2. The identity of the person who provided the service
3. The type of service delivered
4. The date of service
5. The time the service began
6. The time the service ended and where it was delivered

When any of these six elements is absent or conflicts with what's on file, the visit generates an exception. The exception has to be reviewed, and in most cases corrected, before the claim can move forward cleanly.

Exceptions aren't automatically claim denials. They're flags that require human attention. The problem is volume — agencies with 20, 50, or 100+ caregivers generate dozens of exceptions every week, and each one requires individual review. Without a defined workflow, they pile up.

1. Missed Clock-In

The caregiver arrived at the client's home and provided care but never opened the EVV app to start the visit. This is the most common exception in every Texas agency we work with. The visit happened — but there's no electronic record of it starting.

Resolution: A manual entry is required. You need the caregiver's confirmation of the actual start time, a documented reason for the missed clock-in, and a supervisor authorization before the visit can be entered.

2. Missed Clock-Out

The caregiver clocked in but didn't close the visit at end of shift. The system either records an open visit (which blocks the next day's clock-in for that client) or — worse — records an artificially long visit if the system auto-closes at midnight.

Resolution: Same manual correction process as missed clock-in, but you're correcting the end time specifically. Check for downstream errors: if the auto-close created a visit duration outside the authorized range, that triggers a second exception.

3. GPS / Location Mismatch

The caregiver clocked in using the app, but the GPS coordinates at clock-in or clock-out fall outside the verified radius of the client's service address. This happens when the caregiver clocks in from the car instead of inside the home, when apartment buildings create GPS drift, or when the client's address on file doesn't match the actual GPS coordinates of their unit.

Resolution: If the service was delivered at the correct location, you need documentation confirming it: a note from the caregiver explaining the discrepancy, confirmation from the client or a supervisor, and a corrected entry with the explanation documented in the exception record. If the client's address on file is wrong, update it — and audit any prior exceptions that may have been flagged for the same reason.

4. Visit Duration Exception

The visit was clocked in and out, but the total duration is outside the range specified in the authorization. This could be shorter than the minimum authorized duration (suggesting the caregiver left early) or longer than authorized (suggesting unauthorized additional hours were worked).

Resolution: Short visits require confirmation that all authorized tasks were completed. If the visit was legitimately shorter, the claim should reflect the actual time, not the authorized time. Long visits require authorization verification — was an extension approved? If not, the claim should be limited to authorized hours, and the excess time documented.

5. Service Code Mismatch

The EVV record shows a different service type than what was authorized for that visit. This often happens when a caregiver is scheduled for multiple service types across different clients and selects the wrong service when clocking in.

Resolution: Correct the service code in the EVV system to match the actual service delivered, confirm it matches the client's active authorization, and document the reason for the correction. Do not bill for a service that wasn't authorized even if the caregiver delivered it.

6. Caregiver Mismatch

The visit was clocked in under a different caregiver than the one scheduled and authorized for that client. This happens with last-minute shift swaps where the schedule wasn't updated, or when a caregiver logs into another caregiver's profile.

Resolution: Verify which caregiver actually delivered the service. If it was an authorized substitute, update the EVV record to reflect the actual caregiver and document the schedule change. If the substitute was not authorized for that client, there may be a broader authorization issue to address.

7. Manual Entry

A manual entry occurs any time someone at the office enters visit data instead of the caregiver using the app or telephony system. Manual entries are allowed — but they are the most scrutinized exception type in any audit. Every manual entry tells an auditor "someone at the office decided what time this visit started and ended," and that requires a high standard of supporting documentation.

Texas uses Sandata as its EVV aggregator through TMHP (Texas Medicaid & Healthcare Partnership, administered by Gainwell Technologies). Agencies that use Sandata Mobile Connect as their EVV app interact with exceptions directly in the Sandata portal. Agencies using a third-party EVV system (HHAeXchange, AxisCare, etc.) transmit visit data to the Sandata aggregator, and exceptions may surface in either the agency's system or the Sandata portal, depending on where the data mismatch is detected.

In the Sandata portal:

• Exception reports are generated daily and sorted by exception type
• Each exception record shows the original visit data, the reason for the flag, and the correction status
• Corrections are entered directly in the portal with a required reason code and, for manual entries, a supporting documentation attachment
• TMHP auditors have access to the same exception history, including who made each correction and when

Key Sandata correction rules for Texas:

• All corrections must include a reason code identifying why the original data was incorrect
• Manual entries require documentation to be uploaded or noted in the correction record
• The correction timestamp is permanent — it shows exactly how long the exception sat unresolved
• Billing cannot proceed for a visit with an unresolved exception in the Sandata aggregator

HHAeXchange is the most widely used agency management system in Texas Medicaid home care. It has its own internal exception tracking layer that sits between your agency's scheduling data and the Sandata aggregator.

How HHAeXchange categorizes EVV exceptions:

• Visit-level exceptions — triggered by missed clock-ins, clock-outs, GPS mismatches, and duration discrepancies within the HHAeXchange system
• Transmission exceptions — triggered when visit data is transmitted to the Sandata aggregator and doesn't match what TMHP has on file for that client or authorization
• Authorization exceptions — triggered when the EVV record references a service type, date, or duration that isn't covered by the client's current authorization

The correction workflow in HHAeXchange:

1. Pull the daily exception report from the EVV compliance dashboard
2. Review each exception — type, caregiver, client, date
3. Contact the caregiver for visits requiring attestation
4. Enter the correction in HHAeXchange with the appropriate exception reason
5. For manual entries, upload or attach supporting documentation
6. Confirm the corrected record transmits successfully to Sandata

Transmission rejections are the most operationally disruptive exceptions because they affect claims directly. If a visit transmits to Sandata and gets rejected, the claim for that visit cannot process through TMHP until the rejection is resolved at the aggregator level. Some transmission rejections can be corrected at the HHAeXchange level and re-transmitted; others require intervention directly in the Sandata portal.

Whether you're working in Sandata, HHAeXchange, or another EVV platform, the correction process for a billable exception follows the same structure:

Step 1: Identify the exception within 24 hours. Pull exception reports every morning before 10am. Every day you wait makes corrections harder and documentation thinner.

Step 2: Classify the exception. Is this a GPS issue? A missed clock-in? A duration problem? Classification determines the documentation required.

Step 3: Contact the caregiver if needed. For any exception where the actual service data is in question, get caregiver confirmation before correcting. For clock-in/out exceptions, confirm the actual start and end times. For location exceptions, confirm where service was delivered.

Step 4: Collect caregiver attestation. For manual entries and any exception where you're correcting time or location data, document the caregiver's confirmation in writing — even a text message screenshot can serve as supporting evidence. A formal attestation form is better.

Step 5: Enter the correction with a specific reason code. "System error" is not a reason code. "Caregiver forgot to clock in — confirmed via attestation attached" is a reason code. Specificity matters in audits.

Step 6: Obtain supervisor authorization. Every manual correction should be authorized by a supervisor, not just the scheduler or EVV coordinator. This creates a separation of duties that auditors look for.

Step 7: Confirm transmission. If your EVV system feeds into the Sandata aggregator, verify that the corrected record transmitted successfully before closing the exception.

Step 8: Log the resolution. Keep a running exception log — date of visit, exception type, date identified, date resolved, who corrected it, and resolution method. This log is what you produce when a payer or state auditor asks for your EVV compliance history.

The most common audit finding isn't that agencies delivered services that didn't happen. It's that agencies can't prove the services they did deliver were compliant with EVV requirements. Documentation is the difference.

For every manual entry, keep:

• A written reason for why electronic verification wasn't possible (specific to that visit, not a blanket explanation)
• Caregiver attestation signed by the caregiver confirming service time, client, and service type
• Any system logs that support the reason (app crash report, telephony call log, network outage confirmation)
• Supervisor authorization with date and time
• The correction timestamp from your EVV system

Texas TMHP and MCO auditors will specifically examine:

• The ratio of manual entries to total visits (a high ratio is a red flag)
• Whether manual entries cluster around specific caregivers (suggesting a training or compliance issue)
• Whether manual entry reasons are specific or generic
• Whether corrections were made promptly or batch-corrected weeks after service dates

Retention: Keep EVV exception records and supporting documentation for at least six years. TMHP's standard audit lookback is five years, and MCOs may have their own retention requirements. Six years provides margin.

A few Texas rules that affect exception management specifically:

TMHP billing window: Claims submitted to TMHP for Medicaid-funded personal care services must be submitted within 95 days of the service date. EVV exceptions that aren't resolved before billing cutoff can cause claims to miss this window permanently.

MCO EVV compliance thresholds: Texas STAR+PLUS managed care organizations — Superior Health Plan, Molina Healthcare, UnitedHealthcare Community Plan, and Aetna Better Health — each monitor provider EVV compliance rates. While specific thresholds vary by contract, most agencies report that rates below 95% attract MCO attention. Rates below 90% risk corrective action notices that require documented improvement plans.

Telephony as an alternative: When an agency client doesn't have reliable GPS signal (common in rural Texas and some apartment buildings), telephony via the client's landline is an acceptable alternative verification method. If your agency uses telephony, the call record itself serves as the EVV record — document the method used consistently so the verification type on record matches the actual method.

Supplemental Nutrition Assistance and CFC services: Texas Community First Choice (CFC) services have additional documentation requirements on top of standard EVV. If your agency provides CFC services, confirm that your EVV system captures any CFC-specific data elements required by your MCO contracts.

EVV exception management requires consistent daily attention from someone who understands both the EVV system and the billing rules downstream. In agencies without a dedicated person, this work typically falls to the owner — who ends up reviewing exception reports at 7pm instead of growing the business.

The alternative is a back-office team that handles exception review as a defined daily function: pulling reports every morning, contacting caregivers for attestations, entering corrections with proper documentation, and maintaining the exception log for audit readiness.

See how Atlas home care virtual assistants manage EVV exceptions for Texas agencies →

For a broader overview of EVV compliance requirements in Texas — including what the 21st Century Cures Act mandates and how payers enforce compliance — see our EVV Compliance guide for home care agencies.