Arkansas

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(Summary of Changes included in printable PDF below)
CareBridge EVV Integration Guide and Technical Specifications


INTRODUCTION TO CAREBRIDGE INTEGRATION

 

OVERVIEW

Welcome! This Integration Guide is intended to help providers and EVV Vendors throughout the process of integrating with CareBridge to provide EVV data for the purposes of data aggregation. If at any point you have questions, our team here is here to help: evvintegration@carebridgehealth.com.  A PDF of this guide is available here.


WHAT IS CAREBRIDGE?

CareBridge is a company formed to support care for people who receive Long-Term Services and Supports (LTSS). We offer LTSS solutions including an Electronic Visit Verification Platform that can be utilized via a mobile phone, GPS-enabled tablet, landline and web-based portal to record service delivery and facilitate day-to-day management of members’ appointments. CareBridge also supports a wide array of EVV data aggregation solutions in which CareBridge builds an integration with a provider’s EVV system, allowing provider agencies to keep their current EVV solution while still providing required data back to the health plan or state.


INTEGRATION OVERVIEW

CareBridge will engage providers that choose to integrate CareBridge's Platform with a 21st Century Cures Act compliant EVV solution. CareBridge's Platform supports data aggregation by way of accepting EVV Visit Data from third-party vendors and subsequently generating claims to be submitted to the clearinghouse and MCOs.

All EVV Visit and Claims data must ultimately be reflected in the CareBridge Platform for MCO receipt, payment, and monitoring.

The following is a description of the steps in the data aggregation process:

1. Appointments / Visits data file is placed in SFTP folder by provider and/or third-party vendor
2. CareBridge imports and processes Appointments / Visits file
3. CareBridge places response file in SFTP for review by provider and/or third-party vendor
            a.    Provider takes action on response errors and resubmits
4. CareBridge utilizes visits data to generate claims and submits to clearinghouse / MCOs
5. Providers can continue to receive claim remittances through previously established
    mechanisms (Availity)

Appointments / Visits data should be submitted to CareBridge at least once daily for all appointments / visits that have had incremental changes since last submission.

 

SFTP CONFIGURATION REQUIREMENTS

• CareBridge test environment: sftp.dev.carebridgehealth.com
• CareBridge production environment: sftp.prd.carebridgehealth.com
• Port: 22
• Login Credentials: Vendor's public SSH key
• When transferring files via SFTP, select BINARY mode


SFTP FOLDER STRUCTURE

/input – Used to send files to CareBridge for import into the CareBridge system
/output – Used to retrieve Response Files from CareBridge


SFTP RETENTION POLICY

• Once files have been downloaded from /output, they should be deleted. If they are not
   deleted, they will be retained for 30 days.
• Files will be deleted from /input upon load and processing by CareBridge


FILE FORMAT SPECIFICATIONS

• File type: CSV (pipe-delimited),
• Values can be enclosed with double quotes (and should be when a pipe could exist in the data)
• Headers should be included
• One row per appointment / visit
• All DateTime fields should be UTC with zero offset
• Visit data will be rejected if there is already an existing ApptID that has been claimed but has
   not yet reached a terminal status (Rejected, Paid, Denied)


NAMING CONVENTION

Visit Files from Third Party EVV Vendors

The general naming convention is as follows:
VISITS_AR_ProviderTaxID_YYYYMMDDHHMMSS.CSV


For Test Files, “TEST” will prepend the file name as follows:
TEST_VISITS_AR_ProviderTaxID_YYYYMMDDHHMMSS.CSV
Note: The state initials are required for files to be processed.

 

CareBridge Response File

VISITS_AR_ProviderTaxID_ERROR_YYYYMMDDHHMMSS.txt

 

For Test Files, “TEST” will prepend the file name as follows:

TEST_VISITS_AR_ProviderTaxID_ERROR_YYYYMMDDHHMMSS.txt

 

TESTING INSTRUCTIONS

Connection Testing 

In order to test your connection, the file transfer process, and file validation with CareBridge, the following steps must be taken:

  1. Request sFTP credentials by contacting evvintegration@carebridgehealth.com and providing your public SSH key
    • Please generate this key in the OpenSSH format
  2. Two accounts will be created - one for the test environment and one for the production environment
  3. Upload a file in the test environment that includes only column headers. The purpose of this is to ensure that the connection was successful and CareBridge can receive the file
  4. Once the empty file has been processed, pull from the output folder to ensure that you are able to retrieve files from CareBridge
  5. Repeat the process in steps 3 and 4 in the Production environment

Once the connection is confirmed do not send additional files to production until testing is completed in the test environment.


File Validation Testing
(Milestone 2)

The goal of file validation testing is to ensure that vendors can send files that meet the file level specifications.

The process is as follows:

  1. Send a file in the testing environment with 1 or more rows of data and the appropriate column headers
  2. When a response file is returned, review it for any file level errors (row/field) level errors can be ignored at this time
  3. Fix any file level errors and re-submit the file (Note: the re-submitted file will require a different name)
  4. Repeat this process until the response file contains only row / field level errors


Data Validation Testing - Staging

The goal of data validation testing is to ensure that vendors are able to understand row level errors (see Pre-Billing Validation section below) in the response file and develop processes to remedy those errors. 

The process is as follows:

  1. Send a file in the testing environment with actual or test visit/appointment data.
    • We recommend sending 1-5 rows of data initially
  2. Download the response file in the /output folder and review the pre-billing errors.
  3. Update data to remedy those errors; email evvintegration@carebridgehealth.com with questions about specific errors
  4. Repeat steps 1-3 until the only errors remaining in the response file are the following:
    • VCR2012 - Visit is not associated to an authorization
    • VCR2013 - Member is not associated to the visit
    • VCR2023 - Provider is not associated to the visit

Those errors will always be present in staging because the staging environment does not receive daily refreshes of authorization, provider, or member information from our MCO partners.


Data Validation Testing - Production (Milestone 3)

Once a vendor is able to successfully send a file with only the three errors above, they can begin sending production appointment/visit data to the production environment. 

The process is as follows:

  1. Send a file in the production environment with actual visit/appointment data
    • We recommend sending 1-5 rows of data initially
    • We recommend sending visit data with the ClaimAction field as null
    • At least one row of data must be visit data rather than appointment data
  2. Download the response file in the /output folder and review the pre-billing errors.
  3. Update data to remedy those errors; email evvintegration@carebridgehealth.com with questions about specific errors
  4. Repeat steps 1-3 until you receive a response file with headers only. This means that there were no row level errors and the data was processed successfully
  5. Repeat steps 1-4 for each unique provider agency TIN for whom you provide EVV services


Claims Submitted Via CareBridge (Milestone 4)

Once a vendor is able to successfully send a file of appointment/visit data without errors, they can submit their first claim.

The process is as follows:

  1. Re-send the visit data previously sent in Milestone 3 with the ClaimAction field as “N”. This will generate a claim for those visits.
    • Note: If visits sent in Data Validation Testing – Production included the ClaimAction field as “N” rather than null, Milestones 3 and 4 would be completed simultaneously

Integration "Go-Live" (Milestone 5)

Once a vendor is able to successfully submit a claim via CareBridge, they can begin implementation of integration go-live – submitting all claims via CareBridge.  This will require coordination between the vendor, the agency(ies) they support and CareBridge.

The process is as follows:

  1. Direct all provider agencies that have met Milestone 4 to this site. It contains instructions for their expectations and next steps.
  2. Identify a go-live date with each agency to begin sending all data and communicate that date to CareBridge: evvintegration@carebridgehealth.com
  3. Develop a process with your agency for resolving response file errors on an ongoing basis.
    • It is up to vendors and their agencies whether response files will be passed to their agencies directly or incorporated into the third-party EVV system’s UI.
    • Integrating agencies will not be able to make updates to their data in the CareBridge EVV portal. Updated data should be sent via integration process

DATA FIELD SPECIFICATIONS

CareBridge Response File Format

Field Value Description
ERROR_CODE See sections below The error code indicating the type of issue
ERROR_DESCRIPTION See sections below The description of the error code, this is dynamic based on the error
IS_FILE_ERROR True or False Indicates if the error is a file level error or row / field level error
ERROR_SEVERITY ERROR or WARNING Indicates the severity of the error
FILE_NAME Name of the inbound file Name of the file that was received by CareBridge

In addition to these 5 fields, the CareBridge response file will also contain each field included in the inbound data file for Third-Party EVV Vendor reference.


File Level Validation

Error Number Description
F1001 Unknown file
F1002 Incorrect delimiter
F1003 Data cannot be parsed, it may be incomplete or invalid
F1004 File is a duplicate

 
Appointments / Visits Data File Format

Field No  Field Name  Description  Data Type Required for Scheduled Appointment Required for Completed Visit Example Max Length

VendorName 

Name of EVV vendor sending data

Alphanumeric

Y

Y

EVV Vendor

 

TransactionID 

Unique identifier for the transaction and should be unique in every file. It is only used for tracking and troubleshooting purposes

Alphanumeric

Y

Y

71256731

 

TransactionDateTime 

Time stamp associated with the visit data being sent to CareBridge

Datetime

Y

Y

YYYY-MM-DD HH:MM

“2020-01-01 14:00”

 

ProviderID 

Unique identifier for the provider

Alphanumeric

Y

Y

43134

100

ProviderName 

Name of provider 

Alphanumeric

Y

Y

Home Health, LLC

255

ProviderNPI 

NPI of provider 

Numeric

Y
(required unless the provider is atypical)

Y
(required unless the provider is atypical)

1609927608

10

ProviderEIN 

Tax ID or EIN of provider 

Alphanumeric

Y

Y

208076837

 

9

ProviderMedicaidID

MedicaidID number for Provider

Alphanumeric

Y

Y

982123567

9

ApptID 

Unique identifier for the visit, used to identify an appointment and should be consistent for every appointment update

Alphanumeric

 

Y

Y

1231248391

100

10 

CaregiverFName 

First name of caregiver who completed the visit  

Alphanumeric

Y

Y

John

 

11 

CaregiverLName 

Last name of caregiver who completed the visit  

Alphanumeric

Y

Y

Smith

 

12

CaregiverID 

Unique ID Assigned to caregiver (Employee ID) 

Alphanumeric

Y

Y

982123

 

13

CaregiverLicenseNumber

License number for caregiver

Alphanumeric

N

N

22AA88888888

12

14 

CaregiverMedicaidID

MedicaidID number for caregiver

Alphanumeric

 

Y

Y

982123567

9

15 

MemberFName 

First name of member

Alphanumeric

Y

Y

Jane

 

16 

MemberLName 

Last name of member

Alphanumeric

Y

Y

Johnson

 

17 

MemberDateOfBirth

Date of birth of member

Alphanumeric

N

N

YYYY-MM-DD

 

18

MemberMedicaidID 

Medicaid ID for member - 10 digits

Numeric

Y

Y

3627142405

10

19

MemberID 

If not using Medicaid ID 

Alphanumeric

N

N

47138493

 

20

ApptStartDateTime

Date / Time that the appointment was scheduled to begin

DateTime

Y

N

YYYY-MM-DD HH:MM

“2020-01-01 14:00”

 

21 

ApptEndDateTime

Date / Time that the appointment was scheduled to end

DateTime

Y

N

YYYY-MM-DD HH:MM

“2020-01-01 14:00”

 

22

ApptCancelled

(C) if appointment was cancelled

Alphanumeric

N

N

C

 

23 

CheckInDateTime 

Date / Time that the visit was checked into

Datetime

N

Y

YYYY-MM-DD HH:MM

“2020-01-01 14:00”

 

24

CheckInMethod

EVV (E), Manual (M), IVR (I)

Alphanumeric

N

Y

E

 

25 

CheckInStreetAddress 

Street address where check in occurred

Alphanumeric

 

N

Y

926 Main St

 

26 

CheckInStreetAddress2 

Additional street address info where check in occurred

Alphanumeric

N

N

Suite B

 

27 

CheckInCity 

City where check in occurred 

Alphanumeric

N

Y

Nashville

 

28 

CheckInState 

State where check in occurred  

Alphanumeric

N

Y

TN

 

29 

CheckInZip 

Zip code where check in occurred

Alphanumeric

N

Y

37206

 

30 

CheckInLat 

Latitude of coordinates where check in occurred

Alphanumeric

N


if CheckInMethod=E

##.######

 

31

CheckInLong 

Longitude of coordinates where check in occurred 

Alphanumeric

N


if CheckInMethod=E

###.######

 

32 

CheckOutDateTime 

Date / Time that the visit was checked out of

Datetime

N

Y

YYYY-MM-DD HH:MM

“2020-01-01 14:00”

 

33 

CheckOutMethod

EVV (E), Manual (M), IVR (I)

Alphanumeric

N

Y

E

 

34

CheckOutStreetAddress 

Address where check out occurred

Alphanumeric

N

Y

926 Main St

 

35 

CheckOutStreetAddress2 

Additional address info where check out occurred

Alphanumeric

N

N

Suite B

 

36 

CheckOutCity 

City where check out occurred

Alphanumeric

N

Y

Nashville

 

37 

CheckOutState 

State where check out occurred

Alphanumeric

N

Y

TN

 

38 

CheckOutZip 

Zip code where check out occurred 

Alphanumeric

N

Y

37206

 

39

CheckOutLat 

Latitude of coordinates where check out occurred

Alphanumeric

N

 

Y
if CheckOutMethod=E

##.######

 

40

CheckOutLong 

Longitude of coordinates where check out occurred 

Alphanumeric

N

 

Y
if CheckOutMethod=E

###.######

 

41

CheckinDistance

Distance from visit location (miles)

Decimal

N

N

0.125

 

42

CheckoutDistance

Distance from visit location (miles)

Decimal

N

N

0.125

 

43 

CheckinLocationReason

Reason check in was outside of 1/8 mile geofence

Alphanumeric

N

Y

See Check in/out Location Codes table below

 

44 

CheckoutLocationReason

Reason check out was outside of 1/8 mile geofence

Alphanumeric

N

Y

See Check in/out Location Reasons Codes table below

 

45 

AuthRefNumber 

Authorization Number as indicated by health plan

Alphanumeric

Y

Y

1080421390

 

42 

ServiceCode 

Service code for services rendered during visit (HCPCS Procedure Code)

Alphanumeric

Y

Y

S5125

 

46 

Modifier 1 

Modifier code for services rendered during visit

Alphanumeric

N

N

U5

 

47 

Modifier 2 

Second modifier code for services rendered during visit  

Alphanumeric

N

N

UA

 

48 

TimeZone 

Time zone that the visit took place in  

Alphanumeric

Y

Y

US/Eastern

 

49

CheckInIVRPhoneNumber 

Phone Number used to check in 

Alphanumeric

N

Y
if CheckInMethod=I

+14156665555

 

50 

CheckOutIVRPhoneNumber 

Phone Number used to check out 

Alphanumeric

N

Y
if CheckInMethod=I

+14156665555

 

51 

ApptNote 

Free text note related to the visit

Alphanumeric

N

N

Scheduling related note

 

52 

DiagnosisCode 

ICD-10 Diagnosis code attributed to the visit

Alphanumeric

N

Y

I50.9

 

 

53 

ApptAttestation 

Member attestation associated with the visit

Alphanumeric

N

Y

See Member Attestation Codes table below

 

54

Rate 

Billed unit rate associated with the visit

Decimal

Y

Y

3.85

 

55

ManualReason 

Reason for manual entry associated with the visit

Alphanumeric

N


Y
if CheckInMethod or CheckOutMethod=M

See Manual Reasons Codes table below

 

56 

EarlyReason

Reason the visit was early

Alphanumeric

N

N
if check in occurred greater than 7 minutes before the scheduled start time

See Early Reasons Codes table below

 

57

EarlyAction

Action taken due to visit being early

Alphanumeric

N

N
if check in occurred greater than 7 minutes before the scheduled start time

See Early Actions Codes table below

 

58 

LateReason 

Reason the visit was late

Alphanumeric

N

N
if check in occurred between 7 and 29 minutes after the scheduled start time

See Late Reasons Codes table below

 

59 

LateAction 

Action taken due to visit being late

Alphanumeric

N

N
if check in occurred between 7 and 29 minutes after the scheduled start time

See Late Actions Codes table below

 

60

MissedReason 

Reason the visit was missed

Alphanumeric

N

N
if check in occurred greater than 30 minutes after the scheduled start time

See Missed Reasons Codes table below

 

61

MissedAction 

Action taken due to the visit being missed

Alphanumeric

N

N
if check in occurred greater than 30 minutes after the scheduled start time

See Missed Actions Codes table below

 

62

CarePlanTasksCompleted

Tilda delimited list of tasks completed during the visit

Alphanumeric

N

N

Toileting~Bathing

 

63

CarePlanTasksNotCompleted

Tilda delimited list of tasks not completed during the visit

Alphanumeric

N

N

Laundry~ Trash Removal

 

64

CaregiverSurveyQuestions

Tilda delimited list of survey questions presented to the caregiver

Alphanumeric

N

N

Has the member fallen since the last visit?~Is the member looking or acting different than they usually do?

 

65

CaregiverSurveyResponses

Tilda delimited list of survey responses to questions presented to the caregiver in the same order as the questions listed in field 64

Alphanumeric

N

N

Yes~No

 

66

ClaimAction 

New Claim (N), Corrected Claim (C), Void (V), Claims Billed Externally-Not Via CareBridge (E) 

Alphanumeric

N

Y

N

 

67

MCOID

Identifies health plan the member is associated with 

Alphanumeric

Y

Y

See MCOID table below

 

101

Claim Invoice Number 1

Claim level invoice number in third-party system

These fields can be used for reconciliation of the
data sent to CareBridge. 
If you would like to use these fields, please contact the CareBridge Integration team at evvintegration@carebridgehealth.com

102

Claim Invoice Number 2

Claim level invoice number in third-party system

103

Line Item Invoice Number 1

Unique identifier of the invoice line item in the third-party

104

Line Item Invoice Number 2

Unique identifier of the invoice line item in the third-party system

 

Member Attestation Codes

Code Description
MA1000 Complete
MA1005 Member Refused
MA1010 Member Unable
MA1015 No Signature (Other)


Manual Reasons Codes

Code Description
MR1000 Caregiver error
MR1005 No access to application or IVR
MR1010 Technical error
MR1015 Duplicates/overlapping
MR1020 Forgot to clock in
MR1025 Missing/waiting for authorization
MR1050 Member Initiated

 

Check in/out Location Reasons Codes

Code Description
LOR1000 Address is incorrect 
LOR1005 Temporary Location
LOR1010 Other

 

Early Reasons Codes

Code Description
ER1000 Caregiver error
ER1005 Technical issue
ER1010 Member rescheduled

 

Early Reason Actions Taken Codes

Code Description
EA1000 Rescheduled 
EA1005 Back-up plan initiated
EA1010 Contacted service coordinator
EA1020 Caregiver checked in early

 

Late Reasons Codes

Code Description
LR1000 Caregiver forgot to check in
LR1005 Technical issue
LR1010 Member would not allow staff to use device
LR1015 Member rescheduled

 

Late Reason Actions Taken Codes

Code Description
LA1000 Rescheduled
LA1005 Back-up plan initiated
LA1010 Contacted service coordinator
LA1015 Contacted PASSE member services
LA1020 Caregiver checked in late

 

Missed Reasons Codes

Code Description
MVR1000 Caregiver did not show up
MVR1005 Caregiver forgot to check in / out
MVR1010 Technical issue
MVR1015 Unplanned hospitalization
MVR1020 Authorization not in place at time of visit
MVR1025 Member or family refused service
MVR1030 Provider agency unable to staff
MVR1035 Member rescheduled

 

Missed Visit Actions Taken Codes

Code Description
MVA1000 Rescheduled
MVA1005 Back-up plan initiated
MVA1010 Contacted service coordinator
MVA1015 Contacted PASSE member services
MVA1020 Service provided as scheduled


MCOID Codes

Code Description
AR_CAR CareSource
AR_SCC Summit Community Care Arkansas
AR_ATC Arkansas Total Care
AR_EMP Empower Healthcare Solutions Arkansas
AR_FFS Arkansas Medicaid Fee-For-Service


Pre-Billing Validation

The following is a full list of pre-billing checks performed in the CareBridge Platform that would prevent a claim from being generated in the CareBridge Platform and would be returned as an error in the response file to the provider that submitted the visit to CareBridge.

Error Number entity_type description

M1000

member

Generic Error

M1001

member

Medicaid Id

M1002

member

First name is missing or invalid

M1003

member

Middle Name

M1004

member

Last name

M1005

member

Address 1

M1006

member

City

M1007

member

State

M1008

member

Zip

M1009

member

Date of birth

M1012

member

Eligibility start date

M1013

member

Eligibility end date

M2001

member

Member not associated to an auth

P1000

provider

Generic Error

P1001

provider

Tax id

P1002

provider

Unique identifier

P1003

provider

Name

P1004

provider

Address 1

P1005

provider

City

P1006

provider

State

P1007

provider

Zip

P1010

provider

Submitter Id

P1012

provider

Must have either npi or alt_npi

A1000

authorization

Generic Error

A1001

authorization

Auth ref no

A1002

authorization

Hcpc

A1003

authorization

Diagnosis code

A1004

authorization

Provider unique id

A1005

authorization

Member unique id

A1006

authorization

Start date

A1007

authorization

End date

A1008

authorization

Units

A1009

authorization

Partition type

A1010

authorization

Modifier 1

A1011

authorization

Modifier 2

A1012

authorization

Modifier 3

A1013

authorization

Modifier 4

A2001

authorization

Provider match

A2002

authorization

Member match

A2005

authorization

Member in-eligible

A2006

authorization

Provider in-eligible

A2007

authorization

Cannot change members

A2011

authorization

No rate found for the procedure code

A2012

authorization

No unit definitions found for the procedure code

A2017

authorization

Invalid npi

VCR1001

appointment

Caregiver First Name

VCR1002

appointment

Caregiver Last Name

VCR1003

appointment

Caregiver License Number

VCR1004

appointment

Vendor name is not valid

VCR1005

appointment

Transaction Id is not valid

VCR1006

appointment

Transaction Date Time is not valid

VCR1007

appointment

Provider Id is not valid

VCR1008

appointment

Provider Name is not valid

VCR1009

appointment

Provider Tax Id is not valid

VCR1010

appointment

Provider NPI is not valid

VCR1011

appointment

Member First Name is not valid

VCR1012

appointment

Member Last Name is not valid

VCR1013

appointment

Member Medicaid Id is not valid

VCR1014

appointment

Appointment Start DateTime is not valid

VCR1015

appointment

Appointment End DateTime is not valid

VCR1016

appointment

EVV CheckIn DateTime is not valid

VCR1017

appointment

EVV CheckIn Method is not valid

VCR1018

appointment

EVV CheckIn Street Address is not valid

VCR1019

appointment

EVV CheckIn City is not valid

VCR1020

appointment

EVV CheckIn State is not valid

VCR1021

appointment

EVV CheckIn Zip is not valid

VCR1022

appointment

EVV CheckIn Latitude Longitude is not valid

VCR1023

appointment

EVV CheckOut DateTime is not valid

VCR1024

appointment

EVV CheckOut Method is not valid

VCR1025

appointment

EVV CheckOut Street Address is not valid

VCR1026

appointment

EVV CheckOut City is not valid

VCR1027

appointment

EVV CheckOut State is not valid

VCR1028

appointment

EVV CheckOut Zip is not valid

VCR1029

appointment

EVV CheckOut Latitude Longitude is not valid

VCR1030

appointment

Manual CheckIn DateTime is not valid

VCR1031

appointment

Manual CheckIn Method is not valid

VCR1032

appointment

Manual CheckIn Street Address is not valid

VCR1033

appointment

Manual CheckIn City is not valid

VCR1034

appointment

Manual CheckIn State is not valid

VCR1035

appointment

Manual CheckIn Zip is not valid

VCR1036

appointment

Manual CheckOut DateTime is not valid

VCR1037

appointment

Manual CheckOut Method is not valid

VCR1038

appointment

Manual CheckOut Street Address is not valid

VCR1039

appointment

Manual CheckOut City is not valid

VCR1040

appointment

Manual CheckOut State is not valid

VCR1041

appointment

Manual CheckOut Zip is not valid

VCR1042

appointment

Auth Reference Number is not valid

VCR1043

appointment

Service Code is not valid

VCR1044

appointment

Time Zone is not valid

VCR1045

appointment

CheckIn IVR Phone Number is not valid

VCR1046

appointment

CheckOut IVR Phone Number is not valid

VCR1047

appointment

Diagnosis Code is not valid

VCR1048

appointment

Attestation is not valid

VCR1049

appointment

Rate is not valid

VCR1050

appointment

Invalid Manual Reason is not valid

VCR1051

appointment

Invalid Late Reason is not valid

VCR1052

appointment

Invalid Late Action is not valid

VCR1053

appointment

Invalid Missed Reason is not valid

VCR1054

appointment

Invalid Missed Action is not valid

VCR1055

appointment

Invalid Claim Action is not valid

VCR1056

appointment

MCO Id is not valid

VCR1058

appointment

Employee Id is not valid

VCR1059

appointment

Early visit reason is not valid

VCR1060

appointment

Early visit action is not valid

VCR1061

appointment

EVV CheckIn distance

VCR1062

appointment

EVV CheckOut distance

VCR1063

appointment

EVV CheckIn reason is not valid

VCR1064

appointment

EVV CheckOut reason is not valid

VCR1065

appointment

Survey questions and responses are required

VCR1066

appointment

Appointment does not contain the same number of survey questions and answers

VCR1067

appointment

Caregiver tasks are required

VCR1068

appointment

Caregiver hire date is not valid

VCR1069

appointment

Caregiver type is not valid

VCR1070

appointment

Caregiver gender is not valid

VCR1071

appointment

Caregiver date of birth is not valid

VCR1072

appointment

Claim 1 invoice number is not valid

VCR1073

appointment

Claim 2 invoice number is not valid

VCR1074

appointment

Line 1 invoice number is not valid

VCR1075

appointment

Line 2 invoice number is not valid

VCR1076

appointment

Caregiver Medicaid Id is not valid

VCR1077

appointment

Appointment Id is not valid

VCR1078

appointment

Provider Medicaid Id is not valid

VCR1079

appointment

Member date of birth is invalid

VCR1080

appointment

Payer claim number 1 is not valid

VCR1081

appointment

Billing status 1 is not valid

VCR1082

appointment

Billed amount 1 is not valid

VCR1083

appointment

Billed units 1 is not valid

VCR1084

appointment

Paid amount 1 is not valid

VCR1085

appointment

Paid units 1 is not valid

VCR1086

appointment

Payer claim number 2 is not valid

VCR1087

appointment

Billing status 2 is not valid

VCR1088

appointment

Billed amount 2 is not valid

VCR1089

appointment

Billed units 2 is not valid

VCR1090

appointment

Paid amount 2 is not valid

VCR1091

appointment

Paid units 2 is not valid

VCR1092

appointment

Invalid claim action

VCR2001

appointment

Member is not eligible for visit duration

VCR2002

appointment

Provider is not active during visit duration based on provider active_start & active_end date

VCR2003

appointment

"Billed units exceeds max units for Authorization. Used(#{used}) & Available(#{available}) Max(#{max})"

VCR2004

appointment

"Billed units exceeds max units for Authorization per period(#{part}). Used(#{used}) & Available(#{available}) Total(#{max})"

VCR2005

appointment

"Billed units for HCPC-Mod (#{hcpc}-#{mod1}-#{mod2}) exceeds daily max. Used(#{used_units}) Allowed(#{max_units})"

VCR2006

appointment

Late visit missing late visit reason

VCR2007

appointment

Missed visit missing missed visit reason

VCR2008

appointment

Manual confirmation visit missing Manual confirmation reason

VCR2009

appointment

"Billed units (#{billed}) exceed actual units(#{actual}) based on visit CheckIn and CheckOut"

VCR2010

appointment

"Visit CheckIn(#{appt_start_at}) and CheckOut(#{appt_end_at}) are outside of authorized period(#{auth_start}, #{auth_end})"

VCR2011

appointment

Member does not match authorization

VCR2012

appointment

Visit is not associated to an authorization

VCR2013

appointment

Member is not associated to the visit

VCR2014

appointment

Reject if authorization has block claiming flag set

VCR2015

appointment

Reject if provider has block claiming flag set

VCR2016

appointment

Reject if member has block claiming flag set

VCR2017

appointment

No rate found for the procedure code

VCR2018

appointment

No unit definitions found for the procedure code

VCR2019

appointment

Invalid action given the state of in flight claims

VCR2020

appointment

Visit cannot span more than two days

VCR2021

appointment

Authorization has been termed

VCR2022

appointment

Provider does not match authorization

VCR2023

appointment

Provider is not associated to the visit

VCR2024

appointment

Appointment must contain CheckIn and CheckOut data in order to be claimed

VCR2025

appointment

Appointment overlaps with another appointment

VCR2026

appointment

Early visit is missing early visit reason

VCR2027

appointment

Late visit is missing late visit action

VCR2028

appointment

Missed visit is missing missed visit action

VCR2029

appointment

Early visit is missing early visit action

VCR2030

appointment

EVV CheckIn is outside of the allowed radius require a reason code

VCR2031

appointment

EVV CheckOut is outside of the allowed radius require a reason code

VCR2032

appointment

Vendor is not approved to send claim ICNs

VCR2033

appointment

Vendor is not approved to send line level ICNs

VCR2034

appointment

Cannot submit both claim level and line level ICNs

VCR2035

appointment

Appointment crosses midnight but only 1 ICN was provided

VCR2036

appointment

Appointment does not cross midnight but multiple ICNs were provided

VCR2037

appointment

Appointment is attempting to rollup with other appointments that contain different ICNs

VCR2038

appointment

Vendor is configured to send ICNs but did not send any

VCR2039

appointment

Claim was not submitted within the timely filing window

VCR2040

appointment

Past appointment can no longer be manually modified

VCR2041

appointment

Must have a provider npi or provider medicaid id

VCR2042

appointment

Payer does not support claim generation

VCR2043

appointment

ICNs cannot be re-used for multiple claims

VCR2044

appointment

Caregiver is not active

VCR2045

appointment

Invalid npi

VCR2046

appointment

Visit cannot exceed 24 hours

VCR2047

appointment

Visit duration cannot be zero

VCR2048

appointment

EVV CheckIn cannot be in the future

VCR2049

appointment

EVV CheckOut cannot be in the future

VCR2050

appointment

Manual CheckIn cannot be in the future

VCR2051

appointment

Manual CheckOut cannot be in the future

VCR2052

appointment

Cannot claim a visit in the future

VCR2053

appointment

Visit has an EVV CheckOut without a CheckIn

VCR2054

appointment

Visit has a manual CheckOut without a CheckIn

VCR2055

appointment

Visit requires a modifier or includes a modifier that is not allowed

VCR2056

appointment

Cannot claim a cancelled appointment

VCR2057

appointment

CheckIn phone number only allowed for IVR CheckIns

VCR2058

appointment

CheckOut phone number only allowed for IVR CheckOuts

C2001

claim

Claim could not be rolled up due to in flight claims

C2002

claim

Appointment has 0 units to bill

G1000

NULL

Generic Error

This is a comprehensive list of CareBridge Pre-Billing validation responses – some may not be applicable to your
specific integration.

 

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