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Provider Manual

Personal care services

Last Updated on February 19, 2026

Security Health Plan follows ForwardHealth guidelines for our Medicaid Managed Care Program.

Prior authorization is required for all personal care services. Please see the “Home Care Coverage Criteria” medical policy on the Security Health Plan Medical Policy webpage for information on prior authorization criteria.

In alignment with ForwardHealth, Security Health Plan requires Electronic Visit Verification (EVV) for all Personal Care Worker Services effective for claims with a date of service on or after May 1, 2023. Security Health Plan requires EVV for both personal care worker and live-in personal care workers. Personal Care Worker Service claims with date of service May 1, 2023, and after that do not have an EVV on file will be denied. Units billed exceeding the verified EVV visits will also be denied.

Policy related to prior authorization or service authorization of personal care or supportive home care services is not changing; EVV does not replace prior authorization or service authorization.

Specifically, impacted services are those billed under the following Healthcare Common Procedure Coding System (HCPCS) procedure codes:

  • Personal Care Services
    • T1019 (Personal care services, per 15 minutes, not for an inpatient or resident of a hospital, nursing facility, ICF/MR or IMD, part of the individualized plan of treatment)
    • T1020 (Personal care services, per diem, not for an inpatient or resident of a hospital, nursing facility, ICF/MR or IMD, part of the individualized plan of treatment)
    • 99509 (Home visit for assistance with activities of daily living and personal care [per visit])
      • In alignment with Forward Health update 2023-41 "Nurse Supervisory Visit Service Code 99509 Will Require Use of an Electronic Visit Verification System." For dates of service on and after January 1, 2024, Department of Health Services  (DHS) will require use of an electronic visit verification (EVV) system for workers providing services under personal care service code 99509.
  • Supportive Home Care Services
    • S5125 (Attendant care services; per 15 minutes)
    • S5126 (Attendant care services; per diem)

General information about EVV

EVV is a system that uses technology to verify that authorized services were provided. Through EVV, a worker providing personal care services or supportive home care services sends visit data to an EVV vendor at the beginning and end of each visit using methods such as a mobile application, landline, or fixed device.

Workers using EVV enter information to record:

  • Who receives the service
  • Who provides the service
  • What service is provided
  • Where the service is provided
  • The date of the service
  • The time the service begins and ends

Wisconsin Department of Health Services (DHS) provides an EVV system through Sandata at no cost to Wisconsin providers. All programs, providers, and payers can use the DHS-provided Sandata EVV system. Providers may choose whether to use this system or an alternate EVV system (that is, any system besides the DHS-provided Sandata system). Aside from providing the DHS Sandata system free of charge (including fixed visit verification [FVV] devices, as needed), DHS does not reimburse for costs related to EVV, including hardware, software, or training.

The Sandata system provided by DHS offers three ways to collect EVV information:

  • The Sandata Mobile Connect (SMC) app —The worker uses a smart phone or tablet to check in and out of visits. The app does not require Wi-Fi or cell service at the time of the visit.
    • This is the preferred method because it captures information with the fewest errors.
  • Telephonic Visit Verification (TVV)—The worker uses the member’s landline or fixed Voice over Internet Protocol (VoIP) phone to call in and out of the visit.
    • TVV uses the same technology as 911 to confirm location. Cell phones may not be used for TVV.
  • Fixed Visit Verification (FVV)—At the beginning and the end of the visit, the worker pushes a button on a small device that generates a code. The FVV device does not transmit the EVV information. The codes must later be called in to the TVV line.
    • This is the method of last resort and may only be requested if the worker and the member meet all the criteria in ForwardHealth Handbook Topic #21878.

None of the three methods require cell or internet connection during the visit. Providers can instead choose to use an alternate EVV system (that is, any system besides the DHS-provided Sandata system). Alternate EVV systems must connect with the Sandata aggregator, a technology that collects all EVV information and ensures the validity of the information before it is sent to the assigned payer.

Claim matching to an EVV

Submit claims for home health services to Security Health Plan as normal. We will review to ensure there is an approved authorization on file. If the claim is payable, we will then check if we have received an EVV for the claim line.

Each night Sandata sends verified visits (those that have no errors or missing information) to DHS. DHS then sends the visits in a daily file to Security Health Plan. Security Health Plan will use the file to match claims received.

If a visit is not in a verified status, it will not be sent to DHS and Security Health Plan. The provider must correct or add the missing information in the EVV system.

Manually entered or corrections to visit information

It is best practice to capture all EVV information during the visit in order to prevent additional administrative work after the visit, claim denial, or other negative consequences. DHS and Security Health Plan recognize this is not possible in all cases and you may have to manually enter or correct visit information in order to fully and accurately capture the details of the visit. Manually entered visits should only be used when absolutely necessary.

  • Providers using the DHS-provided Sandata EVV system should enter this information using the provider’s Sandata EVV Portal.
  • Providers using an alternate EVV system should refer to their vendor for instructions on how to create or correct visit information manually.

All manually entered visits and corrections will require an associated reason code to explain why the EVV data was created or changed and will be reviewed for compliance with policy. The provider must retain and maintain documentation of the reason for manual entry or corrections.

DHS Resources