Illinois IDoA EVV and S5130 Billing Requirements
A plain-English reference for Illinois IDoA homemaker agencies: EVV rollout dates, the six required elements, geofence, 75% quarterly rule and S5130 modifiers.
Resources
Who this applies to
Hitanshu Rami, CTO & Co-Founder, Verveware
A reference for non-medical home care agencies serving Illinois Department on Aging (IDoA) customers. We keep it updated as the state and its aggregator publish changes.
IDoA homemaker services, billed as S5130, are in scope for EVV. Illinois Department of Human Services–Division of Rehabilitation Services (DRS) providers moved onto the same system at the same time (HFS).
How Illinois EVV is set up
The 21st Century Cures Act (2016) requires states to use EVV for Medicaid-funded personal care services. (HFS)
Illinois chose HHAeXchange in March 2022 as its EVV vendor and data aggregator. (HFS)
Illinois is a hybrid state: you may use any qualified EVV system, but visit data must be sent to the state aggregator through the Electronic Data Interchange (EDI) process. (HFS)
IDoA and DRS visit data began flowing to the aggregator on March 2, 2026. (HFS)
Rollout milestones
Portal access opened January 26, 2026; IDoA member and authorization data loaded February 2; DRS data loaded February 13; EVV went live March 2.
What makes a visit compliant
A visit is compliant only when the clock-in and clock-out are done through the EVV technology and all six Cures Act elements are captured: who provided the service, who received it, what service, the date, start and end times, and location. Any visit needing a manual entry or adjustment counts as non-compliant. (HFS policy. The same rule applies to IDoA.)
Also:
Clock-in and clock-out must fall within 500 feet of the customer's home.
Paper timesheets don't make a visit compliant; still record the visit and keep documentation for audits.
Task entries don't change your compliance rate, though payers may still require them to pay claims.
If you must edit a visit because of a system outage, give the outage as the edit reason.
Caregiver records
Caregiver records must include the full Social Security number. (HFS policy; this applies to IDoA and DRS providers too.)
The 75% quarterly rule
At least 75% of visits in each state fiscal year (SFY) quarter must be compliant; the rate is measured per quarter and doesn't carry over (HFS policy). IDoA and DRS agencies were expected to meet it starting with the April 1–June 30, 2026 quarter.
Tracking: the aggregator issues a Know Your Numbers (KYN) compliance report (HFS policy); it is sent on the 15th of each month to administrator profiles, and any agency — including EDI agencies — can run compliance reports in the portal to reconcile against its own system.
S5130 billing modifiers for Illinois MCO payers
Starting October 1, 2026, Illinois MCO payers expect two modifiers on S5130 homemaker claims where they apply:
XE — a second visit to the same customer on the same day.
TF — the enhanced rate tied to employee insurance.
Required billing fields
IDoA Community Care Program (eCCPIS) billing
IDoA homemaker (in-home) services are billed through eCCPIS, IDoA's Community Care Program system. Each customer gets one bill line per day of service.
Field | What to enter |
|---|---|
CCU number | The Care Coordination Unit (CCU) contract number assigned to the customer's case. |
Customer number | The customer's nine-digit eCCPIS client ID (add leading zeros if needed). |
Customer name | The customer's last and first name. |
Provider contract number | Your agency's IDoA provider contract number. |
Service month and day | The service month plus the day of service. |
Units | Hours delivered that day (1 unit = 1 hour). |
As of January 1, 2026, IDoA's in-home service rate is $30.80 per hour, or $32.57 per hour with the health insurance add-on (IDoA CCP current rates).
Illinois Medicaid MCO claims (S5130)
When an IDoA customer is enrolled in a Medicaid MCO, homemaker claims go to that MCO, not to HFS. These are the core fields; check your MCO for any extra requirements.
Field | What to enter |
|---|---|
Medicaid ID | The customer's nine-digit Recipient Identification Number (RIN), with no spaces or punctuation. |
Date of birth | The customer's date of birth. |
Name, address and gender | The customer's name, street address and gender. |
Taxonomy | The billing provider taxonomy code that fits the service billed. |
Procedure code | S5130 (homemaker). |
Units | 15-minute units (for example, 2 hours = 8 units). |
Modifiers | XE for a second visit to the same customer on the same day; TF for the enhanced rate tied to employee insurance (from October 1, 2026). |
Date of service | The date of service on each claim line. |
Sources: HFS 837P companion guide, HFS EDI FAQ, HFS Chapter 100 handbook.
VA community care claims
For Veterans getting home care through VA community care, the claim has to tie back to an approved VA referral. See how Verveware handles VA billing.
Field | What to enter |
|---|---|
Veteran ICN | The Veteran's 17-character VA Integration Control Number (10 digits, "V", 6 digits) in the insured's ID field. It's on the VA referral. |
Authorization number | The authorization number from the approved VA referral. It's required for all non-emergency care. |
Date of birth | The Veteran's date of birth. |
Billing codes | Accurate codes for services that fall within the scope of the referral. |
Submit to the payer named on the referral. Source: VA provider claims.
Your two options
State-sponsored aggregator portal. Open to agencies of any size; its support team handles system questions, and authorization problems go to the payer (MCO, DRS or IDoA). If an authorization issue is holding up visits, Verveware can help you sort out what the payer needs.
Your own EVV system. It must send visits to the aggregator under Illinois' EDI specifications (HFS). Onboarding starts with the Illinois API Attestation Form.
How Verveware fits
Verveware's EVV connects to the Illinois aggregator by EDI for IDoA and DRS, tracks your compliance rate in real time, works offline on the caregiver app, and handles IDoA batch files and remittance. See EVV, IDoA billing and our Illinois aggregator video. Verveware supports your records; it doesn't replace documentation IDoA, DRS or your payers require.
Official source: Illinois HFS — Electronic Visit Verification. Questions on state policy: HFS.EVV@illinois.gov.
