Nebraska's EVV Audit Triggered New Rules — Here's What Providers Need to Know

Nebraska's EVV enforcement tightened in 2025 not because of a federal deadline, but because of a state audit. That distinction matters — it means the changes are ongoing, the state is actively monitoring compliance, and further enhancements are expected as the audit's mandated improvements continue to roll out.

What Triggered the Changes

Nebraska DHHS implemented a new EVV system for home health providers on January 1, 2024, requiring all providers to capture visits in Netsmart (Mobile Caregiver+) and submit claims through the Netsmart platform. The transition went live under an open model — providers could use alternate EVV vendors as long as they integrated with Netsmart.

What followed revealed gaps. A state audit identified compliance issues across the EVV system and mandated a series of system improvements. The result was a phased set of new claim validation requirements, originally targeted for May 2025, extended to July 9, 2025, then pulled forward to June 25, 2025 for most providers.

What Changed in June 2025

The June 2025 update introduced hard claim denial triggers that didn't exist before:

Claims are declined if a caregiver or independent provider logs more than 16 hours of visits in a single day for applicable service codes. Claims are declined if a recipient is recorded as receiving more than 16 hours of services in a single day. Most critically, claims are declined if the caregiver's NPI is not linked to the EVV visit — a new requirement that catches providers whose caregiver records in Netsmart weren't updated to include NPI numbers.

All of these apply to alternate EVV vendors as well. Providers who assumed their third-party system was automatically pulling compliant data through to Netsmart without NPI linkage were caught off guard.

The Two-System Problem

Nebraska is one of the few states that runs two separate EVV platforms simultaneously by program type. PAS, AD Waiver, and TBI services all run through Netsmart. DD waiver programs — including the Community DD Waiver and the DDAD Waiver — run through Therap. Providers serving members across both program types are managing two different EVV workflows, two different claim release processes, and two different sets of compliance rules.

For DD providers billing through Therap, the four critical error codes — NOSL, VVER, VIVR, and VLOC — have always been the primary compliance risk. A visit with no scheduled location, a missing verification method, an unregistered IVR number, or a location outside the geofence is unbillable without a formal Force Pay by State adjustment request. Manual claim workarounds don't exist. The adjustment process requires documentation, DHHS review, and time — none of which help with cash flow in the short term.

What Providers Should Audit Now

Pull your Netsmart caregiver registry and confirm every active caregiver has a valid NPI linked to their profile. Review your June 2025 denial reports for any claims blocked by the new daily hour caps or NPI requirements. For DD providers in Therap, audit your critical error rate and identify any workers generating repeat VIVR or VLOC errors — those are workflow problems, not one-off mistakes.

If you're using an alternate EVV vendor, contact your vendor to confirm their integration is current with the June 2025 specification updates. The state's guidance was explicit: the new requirements apply to alternate vendors equally.

Nebraska's audit-driven compliance environment means the standard isn't standing still. The providers who stay ahead of it are the ones treating every EVV enhancement as an operational update — not a compliance burden to defer.