Every exception type that appears in a Sandata EVV export has a specific trigger, a typical operational cause, and a defensible resolution path. Georgia home health and PCS agencies that treat exceptions as a monthly housekeeping task — rather than an audit-defense document — are the ones that get caught flat-footed when a DCH or MCO review asks for resolution documentation. This guide walks through each exception category in operational detail.
What Counts as an EVV Exception in Sandata?
An exception is any visit record that fails one or more of Sandata's validation checks — a missing field, a location mismatch, a duration outside the authorized window, or a claim with no matching visit record. Sandata flags these at the point of data ingestion and surfaces them in the provider portal for review and resolution.
Location Exception: What Triggers It and How to Resolve It
Typical cause: GPS signal drift in rural or multi-unit residential settings, a caregiver clocking in before arriving on-site, or a patient address of record that hasn't been updated after a move.
How it's flagged: Sandata compares clock-in/clock-out GPS coordinates against the patient's address of record and flags any deviation beyond the system's tolerance radius.
Resolution timeframe to target: Within 5 business days of the visit. Longer-standing location exceptions are harder to explain credibly during a retrospective audit.
Documentation for audit defense: A short written note confirming the correct address, the reason for the GPS deviation, and confirmation the visit occurred as billed — attached to the visit record in your internal exception log.
Duration Exception: What Triggers It and How to Resolve It
Typical cause: A caregiver forgetting to clock out, a visit legitimately running long due to a clinical need, or a visit clocked in and out within minutes due to a system error.
How it's flagged: Sandata compares the visit's logged duration against the authorized service window for that service type and participant.
Resolution timeframe to target: Within 5 business days, with same-day correction where the cause is a forgotten clock-out.
Documentation for audit defense: A corrected time entry with a brief explanation, ideally corroborated by a caregiver attestation or supervisor note for any correction exceeding 30 minutes.
Missing Field Exception: What Triggers It and How to Resolve It
Typical cause: Incomplete data transmission from an alternate EVV vendor, a caregiver skipping a required field in a mobile app, or a telephony call that dropped before all six data points were captured.
How it's flagged: Sandata validates that all six federally required data points — service type, patient identity, date, location, caregiver identity, and start/end time — are present before accepting the record as clean.
Resolution timeframe to target: Within 3 business days — missing field exceptions are typically the fastest to correct once identified, since the underlying visit usually did occur.
Documentation for audit defense: The completed field entry plus a brief note on why it was initially missing, particularly useful if the pattern points to a system integration issue that needs a permanent fix.
Unmatched Claim: What Triggers It and How to Resolve It
Typical cause: A claim submitted for a visit that was never entered into Sandata, a data transmission failure between the provider's system and Sandata, or a visit logged under a different patient or caregiver identifier than the one on the claim.
How it's flagged: Sandata's claims matching process cross-references submitted claims against its visit record database and flags any claim with no corresponding EVV record.
Resolution timeframe to target: Immediately upon identification — this is the highest-risk exception category and the one most likely to trigger recoupment if left unresolved before claim submission.
Documentation for audit defense: Evidence the visit occurred (corrected EVV entry, or a documented data transmission failure with the correction applied) attached to the claim file before resubmission.
Duplicate Visit Record: What Triggers It and How to Resolve It
Typical cause: A visit entered both through a mobile app and a telephony backup call, or a caregiver re-submitting a visit after an app error without realizing the first entry went through.
How it's flagged: Sandata flags multiple visit records for the same caregiver and patient with overlapping or identical timestamps.
Resolution timeframe to target: Within 5 business days — duplicate records left unresolved risk double-billing, which carries its own recoupment and overpayment exposure separate from the EVV exception itself.
Documentation for audit defense: A record of which entry is the system of record and which was voided, with a brief note on the cause.
How Should Agencies Document Resolution for Audit Defense?
An exception log that shows a date flagged, a date resolved, a documented reason, and the corrective action taken is the single most useful artifact in a DCH or MCO audit response. Agencies without a written resolution process tend to resolve exceptions ad hoc in the Sandata portal with no external record — which means there's nothing to hand an auditor six months later when the exception rate itself becomes the finding.
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