Prognosis Consulting / Home Health & PCS / EVV Exception Audit
Pillar II · Protection

EVV Exception Audit

A single audit run across 90 days of your Sandata export. Every exception flagged. Every dollar of recoupment exposure quantified. Delivered as a branded exception log and PDF risk summary.

Methodology

What the audit covers.

Every visit record in your 90-day export is run against six exception categories, cross-referenced against your active caregiver roster.

Location Verification

GPS coordinates flagged where caregiver location at clock-in/out doesn't match patient's address of record.

Visit Duration Outliers

Visits logged outside authorized service hours — too short (potential fraud) or too long (billing exposure).

Missing Required Fields

Any visit record missing one or more of the six federally required EVV data points.

Unmatched Claims

Claims submitted to Medicaid with no corresponding EVV record — the highest-risk exception category.

Duplicate Visit Records

Same caregiver, same patient, overlapping timestamps — a common system data error with significant audit implications.

Caregiver Credential Cross-Check

EVV records cross-referenced against your active caregiver roster to flag visits logged by caregivers with lapsed credentials or unverified qualification status.

The Deliverable

What you receive.

Branded Exception Log (Excel)

All flagged records, categorized by exception type, with columns for visit date, caregiver ID, patient ID, exception category, and estimated dollar exposure.

PDF Risk Summary

An executive-ready summary of total exception rate, top exception categories, estimated recoupment exposure, and prioritized remediation recommendations.

Pricing

One-Time EVV Audit

Priced by visit volume across the 90-day window. Add a caregiver roster screen for a single bundled deliverable.

Standard
$499
up to 90 days · up to 200 visits
  • Full six-category exception analysis
  • Branded exception log (Excel)
  • PDF risk summary
  • Delivered within 5 business days
Custom
Custom
500+ visits · scoped on request
  • Volume-based pricing
  • Multi-location aggregation available
  • Scoped after a discovery call
Add-on: LEIE Caregiver Roster Screening — $149 flat. Bundle pricing: Audit + Roster Screen — $599 / $899.
Process

From intake to findings.

01

Secure File Transfer

You export your Sandata EVV data and send via encrypted file transfer. No PHI required — we work with de-identified visit records.

02

Exception Analysis

Our tool runs structured exception logic against your data: all six required EVV fields, location verification, duration analysis, claim matching.

03

Findings Delivery

You receive your exception log and PDF risk summary within 5 business days.

04

Optional Remediation Call

A 30-minute walkthrough of findings with prioritized next steps. Included with all engagements over $499.

Get Started

Ready to see your
exception exposure?

Submit a request and we will confirm scope, pricing tier, and secure file transfer instructions within one business day.