Connecticut's EVV Denial Wave: What HUSKY Health Providers Need to Know

Connecticut providers had a rough second half of 2024. Starting with dates of service July 1, 2024, the Department of Social Services began enforcing EVV-linked claim denials for home health and personal care services — and the bulletins kept coming through the fall.

What Changed

Connecticut's EVV mandate has been rolling out in phases. Personal care services came under the requirement first, with home health care services following by January 1, 2024. DSS selected Sandata as the state's EVV aggregator, operating under an open model — meaning providers can use an alternate EVV system, but all visit data must flow through Sandata before claims are adjudicated.

For most of 2023 and into 2024, DSS exercised patience with providers still getting their EVV workflows in order. That patience ended mid-year. Beginning July 1, 2024, DSS hardened enforcement: visits without a matching EVV record in Sandata became grounds for denial.

The Data-Matching Problem

The most common failure point isn't that providers aren't using EVV — it's that EVV data isn't making it to Sandata cleanly. Providers using alternate EVV systems must ensure their visit records are transmitted in Sandata's required format. Missing data fields, incorrect caregiver identifiers, or timing mismatches between the visit record and the claim all create the same result: no matching EVV record, denied claim.

There's also an eligibility layering issue unique to Connecticut's system. A client must appear eligible in CMAP — DSS's billing portal — before they will be active in the Sandata EVV system. Being present in one system doesn't guarantee the other, and prior authorization doesn't confirm EVV eligibility. Providers who skip the eligibility verification step before a visit are setting themselves up for a denial they can't easily appeal.

What Providers Should Be Doing Now

Every EVV workflow should include three checkpoints before a claim goes out: confirm the client is active in both CMAP and Sandata, verify the EVV visit record transmitted successfully with all six required data elements, and ensure the visit data matches the claim in terms of date, service code, and caregiver.

DSS is monitoring compliance and has the authority to move toward recoupment for providers who remain out of sync. A formal rulemaking process and continued tightening of enforcement is expected through 2025 and 2026.

Agencies that treat EVV as a documentation step separate from billing are the most exposed. When EVV data flows directly into the claims process — and discrepancies are flagged before submission — denials become the exception, not the pattern.