Sandata and HHAeXchange in PA: Who Does What

HHAeXchange and the DHS EVV aggregator have different roles in Pennsylvania, and mixing them up is how a visit gets fixed in the wrong place. When something goes wrong, start by asking which step it belongs to: visit capture, authorization, prebilling or transmission to the aggregator.

The short version: in Pennsylvania, HHAeXchange is how most personal care agencies work with their Community HealthChoices MCOs, and Sandata runs the state's EVV aggregator, which receives the EVV data for Medicaid-funded personal care visits. They do different jobs. Knowing which one is which tells you where to fix a visit, where a claim is being held and who to contact.

This is general information, not legal or billing advice. Your MCO provider agreement and the DHS bulletins linked below are the final word for your agency.

Pennsylvania's "Open Choice" model

Pennsylvania did not force every provider onto one EVV system. MA Bulletin 07-20-04 (September 10, 2020) explains that "the Department established an open EVV system model that enables providers and MCOs to choose an EVV system that best suits their operations and needs." Rules and configuration are still set by the Department.

An open model needs one place where all the data comes together. The same bulletin says it "requires the use of an EVV Aggregator to consolidate data from all EVV systems, apply standard business rules to ensure PCS visits are properly and consistently verified, and generate alerts when PCS visit data does not conform to these standards."

So there are two layers:

1. The system where the visit is captured. This can be the MCOs' system (HHAeXchange), an approved alternate system the agency chose, or, for fee-for-service visits only, the free DHS EVV system. The free DHS system does not capture visits for MCO submission; for CHC visits, use the MCO's EVV system or an alternate system that meets each plan's integration requirements.
2. The DHS EVV Aggregator, where all visits land and where the state checks them against claims.

For Office of Long-Term Living and Community HealthChoices programs, the services under EVV include Personal Assistance Services, Respite (unlicensed settings only) and Participant-Directed Community Supports.

Sandata: the state's system and aggregator

MA Bulletin 05-20-03 (August 2020) says it plainly: "The Department utilizes the Sandata EVV system." The current DHS EVV page says DHS "is working with Gainwell Technologies and Sandata to develop an EVV system that will integrate with our existing Medicaid Management Information System (MMIS), PROMISe."

In practice, Sandata does three things in Pennsylvania:

• Runs the free DHS EVV system, which eligible providers can use to capture fee-for-service visits only. It is separate from the aggregator described next.
• Runs the DHS EVV Aggregator, where the state matches visits to claims and measures the 85% manual edit standard. The aggregator includes an "EVV Compliance" report providers can use to check their rate.
• Certifies alternate EVV vendors. According to the DHS Alternate EVV page, providers who want to use their own system should first contact the Sandata Alternate EVV support group (PAAltEVV@sandata.com, 855-705-2407).

DHS's list of "Vendors Certified for PA DHS EVV," dated March 1, 2026, has 98 entries, including HHAeXchange, AxisCare, Alora, CareSmartz360, WellSky, Axxess and KanTime. In other words, the open model is still in use.

HHAeXchange: the MCOs' provider portal

Pennsylvania's three Community HealthChoices plans (AmeriHealth Caritas/Keystone First CHC, PA Health & Wellness and UPMC Community HealthChoices) use HHAeXchange as the EVV system and portal for their providers. The DHS EVV page says providers serving CHC participants "will have the option to use the MCO's EVV system, HHAeXchange." HHAeXchange's own Pennsylvania CHC page says the three plans "have selected HHAeXchange."

For an agency, the HHAeXchange portal is where most day-to-day work with the plan happens. HHAeXchange's PA CHC page lists:

• "Electronic case broadcasting, authorizations, plan of care management and entering confirmed visits"
• "Real-time two-way messaging with each MCO"
• Free EVV for providers
• Billing: "All claims will be created through the HHAeXchange Portal and sent electronically via an 837 eBilling file."

Agencies that already have their own EVV system can keep it and connect to HHAeXchange electronically instead. DHS puts it this way: "A CHC-participating provider with its own internal EVV system must work with each contracted MCO."

Used by all three plans, required in writing by one

There is a difference between "used by" and "required by," and it matters if you are choosing or changing systems.

• PA Health & Wellness put it in writing. Effective October 19, 2020, W1793 (Personal Assistance Services) and T1005 (Respite) "can only be billed through HHAeXchange," and claims for those codes "will reject, deny, or be subject to recoupment if not received through HHAeXchange." Third-party EVV vendors are acceptable "as long as they interface with HHAeXchange," and the letter warns that integration "can take 6 weeks or more."
• Keystone First CHC said in July 2023 that it "will continue its relationship with HHAeXchange." Its April 2026 provider manual requires matching EVV data for W1793 and T1005 claim lines.
• UPMC Community HealthChoices is named by HHAeXchange as one of the plans that selected it. UPMC's own CHC provider manual requires EVV and the 85% standard but does not name a vendor in its text.

So the accurate statement is: HHAeXchange is used by all three CHC plans, and PA Health & Wellness requires it for PAS and respite billing.

Didn't HHAeXchange buy Sandata?

Yes. HHAeXchange announced on October 3, 2024 that it had acquired Sandata Technologies, with HHAeXchange's CEO, Paul Joiner, leading the combined business. The terms were not disclosed, and the press release does not address state aggregator contracts.

For day-to-day operations, follow the current DHS and MCO instructions for your systems. As of this writing, the DHS EVV page still names Sandata and Gainwell, alternate EVV certification still goes through the Sandata support group, and the certified vendor list dated March 1, 2026 includes HHAeXchange as one more vendor that connects to the aggregator. Common ownership does not mean the provider portal and the state aggregator serve the same function, so keep treating them as two systems with separate roles.

What this means day to day

This is where the distinction pays off. Most problems with a visit or a claim fall into one of the rows below.

Situation	Where it lives	What to do
Visit missing a clock-in or clock-out, or wrong location	The EVV system where it was captured (HHAeXchange for most CHC agencies, or your alternate system)	Correct it there, not in the aggregator. Keep supporting documentation. It generally counts as a manual edit.
Visit held before billing	HHAeXchange prebilling	Check the reason: often a visit that does not match the authorization or exceeds its units. This is an authorization check, separate from EVV verification.
Authorization missing, expired or short on units	HHAeXchange, from the MCO	Message the MCO through the portal; contact the participant's service coordinator about the service plan.
Claim denied with an EVV error code	State level (ESC 927, 928, 932) or the MCO	ESC 927: units billed exceed units verified in EVV. ESC 928: no matching PCS visit. Correct the underlying issue in the source system, then follow your payer's resubmission instructions.
Manual edit rate above 15%	DHS EVV Aggregator, EVV Compliance report	Find the source of the exceptions. Two consecutive quarters above 15% lead to corrective action.
Setting up or certifying your own EVV system	Sandata Alternate EVV support (DHS)	PAAltEVV@sandata.com; then build the connection to each MCO.

Where to correct a visit

The DHS EVV FAQ is explicit: corrections are made "in the PA-DHS EVV (not the PA-DHS Aggregator)." In other words, you fix the visit in the system where it was captured, and the corrected data flows back to the aggregator. The FAQ also says that "for any manual entries, however, supporting hard copy documentation should be kept."

Keep in mind that, under MA Bulletin 05-24-01, changes made after the service is delivered generally count as manual edits, and since January 1, 2025 at least 85% of your verified visits must have none. Check your plan's current instructions for specific exceptions, such as PA Health & Wellness's guidance for qualifying midnight-shift corrections. Our guide to Pennsylvania's 85% EVV standard covers that rule in detail, and the free EVV Score Check shows where your current quarter stands.

Where holds happen

Inside HHAeXchange, visits that fail validation are held in prebilling before a claim is created. HHAeXchange's prebilling guide includes reasons such as "The visit exceeded the units allotted by the Authorization," and notes that in some cases the authorization error "cannot be corrected" because the allotted units have already been used.

That is the costly case: hours that were worked and paid to the caregiver but may not be billable as scheduled. Whether a corrected or retroactive authorization helps depends on the payer and the case.

Check authorization and EVV separately. An authorization hold means the visit does not meet the plan's authorization rules. At the state level, MA Bulletin 05-21-04 uses different codes for EVV problems: ESC 927, "PCS Units Billed Exceed Units Verified in EVV," means the units billed exceed the units verified in EVV, and ESC 928, "No Matching EVV PCS Visit Found," means no matching visit was found. Correct the underlying issue in the right system and follow your payer's instructions before resubmitting.

Prevention starts before the visit: schedules built from the active authorization, checked before the week starts. That is the work behind our hours and authorization utilization service.

Who to contact

• About an authorization, a plan of care or a held claim with a CHC plan: the MCO, through HHAeXchange messaging, and the participant's service coordinator for changes to the service plan.
• About using or certifying an alternate EVV system: the Sandata Alternate EVV support group named on the DHS Alternate EVV page.
• About state EVV rules and bulletins: the DHS EVV pages and FAQ linked below.

If you are choosing an EVV setup

Three questions to answer before you decide:

1. Which plans do you bill? If you bill PA Health & Wellness for W1793 or T1005, those claims must go through HHAeXchange, whatever EVV system you use.
2. Do you need a system of your own? If you use an alternate system to capture and submit EVV data, confirm its DHS certification and the integrations each payer requires. PA Health & Wellness warns that the integration "can take 6 weeks or more." Scheduling or payroll software on its own is a separate question.
3. Who watches both sides? HHAeXchange shows you the plan's view: authorizations, confirmed visits, prebilling. The aggregator shows the state's view: verified visits and your manual edit rate. Looking at only one of them means finding out about some problems late.

How Concepts Central Support helps

We work inside HHAeXchange and your EVV system every day: reviewing exceptions, clearing prebilling holds and checking schedules against active authorizations before visits happen. See our EVV monitoring and hours and authorization utilization services, or check your current quarter with the free EVV Score Check.

Sources

• PA DHS, OLTL/ODP Bulletin 07-20-04 et al., "EVV for Personal Care Services" (September 10, 2020)
• PA DHS, MA Bulletin 05-20-03, "EVV for PCS Provided in the Fee-for-Service Delivery System" (August 26, 2020)
• PA DHS, EVV for Personal Care Services
• PA DHS, Alternate EVV
• PA DHS, Free DHS EVV Solution (Fee-for-Service Only)
• PA Health & Wellness, Electronic Visit Verification (EVV), including Midnight Shifts
• PA DHS, Vendors Certified for PA DHS EVV (March 1, 2026)
• PA DHS, EVV FAQ
• PA DHS, MA Bulletin 05-24-01 et al., "Updated EVV Manual Edits Compliance Percentage Requirements" (August 23, 2024)
• PA DHS, MA Bulletin 05-25-03 et al., "EVV Manual Edits Noncompliance" (August 29, 2025)
• PA DHS, MA Bulletin 05-21-04 et al., "Updated ESC Descriptions for PCS Subject to EVV" (October 22, 2021)
• HHAeXchange, Pennsylvania Community HealthChoices Provider Information Center
• HHAeXchange, "HHAeXchange Acquires Sandata Technologies" (October 3, 2024)
• HHAeXchange, Enterprise Process Guide: Prebilling
• PA Health & Wellness, "EVV Communication Effective 10.19.2020 V4"
• Keystone First CHC, "EVV System Soft Launch" (July 10, 2023)
• Keystone First CHC, Provider Manual (April 2026)
• UPMC Health Plan, 2025 Provider Manual, Chapter N, UPMC Community HealthChoices