New Jersey

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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_NJ_ProviderTaxID_YYYYMMDDHHMMSS.CSV


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

CareBridge Response File

VISITS_NJ_ProviderTaxID_ERROR_YYYYMMDDHHMMSS.txt

 

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

TEST_VISITS_NJ_ProviderTaxID_ERROR_YYYYMMDDHHMMSS.txt

 

TESTING INSTRUCTIONS

Testing Overview 

Vendors are required to complete testing scenarios in order to begin sending production data to CareBridge. If a vendor has already completed the integration process in New Jersey and is sending production data for PCS Procedure Codes, additional testing is not required for Home Health.

The goal of the testing process is to ensure that data is able to be successfully transmitted from Third-party vendors to CareBridge. CareBridge has created several test cases designed to ensure specific scenarios are understood and passed by vendors prior to production go-live.

 

The test cases are outlined in a separate document: New Jersey - Third-Party EVV Vendor Integration Testing Process Guide, available on the CareBridge EVV Data Integration web page: http://evvintegration.carebridgehealth.com, under Additional Documents for Third-Party Vendors > New Jersey  - Third-Party EVV Vendor Integration Testing Process Guide.

 

Additionally, there are 3 different testing milestones summarized below:

  • Connection Testing – Vendors credentials are working properly and they are able to successful connect to the SFTP site.
  • File Validation Testing – Vendors are able to successfully send files in accordance with our file specifications.
  • Data Validation Testing– Vendors are able to send records in accordance with our data specifications. A full list of CareBridge Pre-Billing Validations can be found under Technical Specifications for Third-Party Vendors > Pre-Billing Validation Errors.


File Validation Testing
(Milestone 2)

Once a vendor has successfully completed the required test cases and is approved to send data to production, they can begin sending production appointment/visit data to the production environment.

CareBridge highly recommends that EVV Vendors follow the process outlined below:

 

  1. Send a file in the production environment with actual visit/appointment data.

    a. Only send 1-5 rows of data initially.
    b. Send visit data with the ClaimAction field as null.
    c. At least one row of data should 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.

Claim Submitted Via CareBridge

Once a vendor is able to successfully send a file of appointment/visit data without errors on behalf of a provider, they can coordinate with the provider to submit their first claim. Note: for Horizon members, claims will not be submitted via CareBridge.  ClaimAction “E” should be used for Horizon visits.

  • Re-send the visit data previously sent in Initial Production Data Go-Live 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, both Data Validation in Production and Claim Submitted via CareBridge would be completed simultaneously.

Integration "Go-Live" 

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 providers using your system to the CareBridge Integration Document for Providers 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.
  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.
    • It is required that vendors leverage both the:
          1. The Pre-Billing Validation Report in addition to response files to ensure providers have the most up-to-date information regarding outstanding visit errors.
          2. The Appointment Status Report to ensure providers have accurate information regarding visit or claim status over time.
    • 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 File is not an expected file type.
F1002 File contains invalid delimiters.
F1003 File cannot be parsed, it may be incomplete or invalid.
F1004 File is a duplicate.
F1005 File exceeds max allowed file size. (5 GB)

 

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

 

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

Y

Y

22AA88888888

12

14 

CaregiverDateOfBirth

Date of birth of caregiver

Alphanumeric

Y

Y

YYYY-MM-DD

 

15 

MemberFName 

First name of member

Alphanumeric 

Y

Y

Jane

 

16 

MemberLName 

Last name of member

Alphanumeric 

Y

Y

Johnson

 

17 

MemberMedicaidID 

Medicaid ID for member - 12 digits

Numeric 

Y

Y

36271424521

12

18

MemberID 

If not using Medicaid ID 

Alphanumeric

N

N

47138493

 

19

MemberDateOfBirth

Date of birth of member

Alphanumeric

N

N

YYYY-MM-DD

 

20

ApptStartDateTime

Date / Time that the appointment was scheduled to begin

DateTime

Y

Y

YYYY-MM-DD HH:MM
“2020-01-01 14:00”

 

21 

ApptEndDateTime

Date / Time that the appointment was scheduled to end

DateTime

Y

Y

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

Y
if CheckInMethod=E

##.######

 

31

CheckInLong 

Longitude of coordinates where check in occurred 

Alphanumeric

N

Y
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


if CheckOutMethod=E

###.######

 

41 

AuthRefNumber 

Authorization Number as indicated by health plan

Alphanumeric

Y

Y unless not required for Service Code (see Home Health Service Codes section below)

1080421390

 

42 

ServiceCode 

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

Alphanumeric 

Y

Y

S5125

 

43 

Modifier 1 

Modifier code for services rendered during visit

Alphanumeric

N

N

U5

 

44 

Modifier 2 

Second modifier code for services rendered during visit  

Alphanumeric

N

N

UA

 

45 

Modifier 3 

Third modifier code for services rendered during visit  

Alphanumeric

N

N

96

 

46

Modifier 4 

Fourth modifier code for services rendered during visit  

Alphanumeric

N

N

59

 

47 

TimeZone 

Time zone that the visit took place in  

Alphanumeric 

Y

Y

US/Eastern

 

48 

CheckInIVRPhoneNumber 

Phone Number used to check in 

Alphanumeric 

N

Y
if CheckInMethod=I

+14156665555

 

49 

CheckOutIVRPhoneNumber 

Phone Number used to check out 

Alphanumeric 

N

Y
if CheckInMethod=I

+14156665555

 

50 

ApptNote 

Free text note related to the visit

Alphanumeric 

N

N

Scheduling related note

 

51 

DiagnosisCode 

ICD-10 Diagnosis code attributed to the visit

Alphanumeric 

N

Y

I50.9

 

 

52

ApptAttestation 

Member attestation associated with the visit

Alphanumeric 

N

Y

See Member Attestation Codes table below

 

53 

Rate 

Billed unit rate associated with the visit 

Decimal 

Y
(required if
ClaimAction= N or C)

Y
(required if
ClaimAction= N or C)

3.85

 

54 

ManualReason 

Reason for manual entry associated with the visit

Alphanumeric 

N

Y
if CheckInMethod or
CheckOutMethod=M

See Manual Reasons Codes table below

 

55

LateReason 

Reason the visit was late

Alphanumeric 

N

Y
if check in occurred between one and three hours after the scheduled start time

See Late Reasons Codes table below

 

56

LateAction 

Action taken due to visit being late

Alphanumeric 

N

Y
if check in occurred between one and three hours after the scheduled start time

See Late Actions Codes table below

 

57

MissedReason 

Reason the visit was missed

Alphanumeric 

N

Y
if check in occurred greater than three hours after the scheduled start time

See Missed Reasons Codes table below

 

58

MissedAction 

Action taken due to the visit being missed

Alphanumeric 

N

Y
if check in occurred greater than three hours after the scheduled start time

See Missed Actions Codes table below

 

59

CarePlanTasksCompleted

Tilda delimited list of tasks completed during the visit

Alphanumeric

N

N

Toileting~Bathing

 

60

CarePlanTasksNotCompleted

Tilda delimited list of tasks not completed during the visit

Alphanumeric

N

N

Laundry~ Trash Removal

 

61

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?

 

62

CaregiverSurveyResponses

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

Alphanumeric

N

N

Yes~No

 

63

ClaimAction 

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

Alphanumeric 

N

Y

N

 

64

MCOID 

Identifies health plan the member is associated with 

Alphanumeric 

Y

Y

See MCOID table below

 

65

CaregiverSSN

Social Security Number of the Caregiver - HHAX application requirement; this is not required by the State of NJ for 1/1/2021 go-live. If you do not wish to send this, please default to sending all nines, ex. ‘999999999’

Alphanumeric

N

Y

999999999

9

66

CaregiverGender

Male (M), Female (F), or Other (O). This is an HHAX application requirement. If you do not wish to send this, please default to Other (O)

Alphanumeric

Y

Y

M

 

67

CaregiverType

Caregiver’s Type. This is an HHAX application requirement.
Possible Value: ‘skilled’, ‘non_skilled’, ‘both’

Alphanumeric

Y

Y

non_skilled

 

68

CaregiverHireDate

Date on which caregiver hired by Provider. This is an HHAX application requirement

Alphanumeric

Y

Y

YYYY-MM-DD

 

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

To enable these fields, additional testing is required.

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

 

PCS Service Codes and Unit Definitions

Service Code Modifier 1 Modifier 2 Unit Type Unit Quantity Payers
S5125 SE  HQ  Minutes 15 NJ_AGP, NJ_HZ, NJ_UHC, NJ_ABH, NJ_WC, NJ_FFS
S5125 SE U3 Minutes 15 NJ_AGP, NJ_HZ, NJ_UHC, NJ_ABH, NJ_WC, NJ_FFS
S5130 HQ   Minutes 15 NJ_AGP, NJ_HZ, NJ_UHC, NJ_ABH, NJ_WC, NJ_FFS

S5130

    Minutes 15 NJ_AGP, NJ_HZ, NJ_UHC, NJ_ABH, NJ_WC, NJ_FFS
T1005     Minutes 15 NJ_AGP, NJ_HZ, NJ_UHC, NJ_ABH, NJ_WC, NJ_FFS
T1019   HQ   Minutes 15 NJ_AGP, NJ_HZ, NJ_UHC, NJ_ABH, NJ_WC, NJ_FFS
T1019  SE UI Minutes 15 NJ_AGP, NJ_HZ, NJ_UHC, NJ_ABH, NJ_WC, NJ_FFS
T1019  SE   Minutes 15 NJ_AGP, NJ_HZ, NJ_UHC, NJ_ABH, NJ_WC, NJ_FFS
T1019  TN   Minutes 15 NJ_AGP, NJ_HZ, NJ_UHC, NJ_ABH, NJ_WC, NJ_FFS
T1019      Minutes 15 NJ_AGP, NJ_HZ, NJ_UHC, NJ_ABH, NJ_WC, NJ_FFS
T1020     Visit 1 NJ_AGP, NJ_HZ, NJ_UHC, NJ_ABH, NJ_WC, NJ_FFS
T1005 HI   U8 Minutes 15 NJ_FFS
T1005 HI   Minutes 15 NJ_FFS
H2016 HI  22 Minutes 15 NJ_FFS
H2016 HI  U8 Minutes 15 NJ_FFS
H2016 HI   Minutes 15 NJ_FFS
H2021 HI  22 Minutes 15 NJ_FFS
H2021 HI  52 Minutes 15 NJ_FFS
H2021 HI   Minutes 15  NJ_FFS

 

Home Health Service Codes and Unit Definitions*

Service Code Modifier 13 Modifier 2 Unit Type Unit Quantity

Horizon AuthRefNumber Required4

97597

 

 

Visit

1

N

996011

 

 

Visit

1

Y

996021

 

 

Each additional hour

1

Y

G0299

 

 

Minutes

15

N

S9122

 

 

Hours

1

Y

S9123

 

 

Hours

1

N

S9124

 

 

Hours

1

N

S9127

 

 

Per Diem2

1

Y

T1000

 

 

Minutes

15

Y

T1000

UA

 

Minutes

15

Y

T1002

 

 

Minutes

15

Y

T1002

UA

 

Minutes

15

Y

T1003

 

 

Minutes

15

Y

T1003

UA

 

Minutes

15

Y

T1030

 

 

Per Diem2

1

Y

T1031

 

 

Per Diem2

1

Y

92507

 

 

Per Diem2

1

Y

92507

96

 

Per Diem2

1

Y

92507

96

59

Per Diem2

1

Y

97110

 

 

Minutes

15

Y

97110

96

 

Minutes

15

Y

97110

96

59

Minutes

15

Y

971291

 

 

Minutes

15

Y

971291

96

 

Minutes

15

Y

971301

 

 

Minutes

15

Y

971301

96

 

Minutes

15

Y

971301

96

59

Minutes

15

Y

97535

 

 

Minutes

15

Y

97535

96

 

Minutes

15

Y

97535

96

59

Minutes

15

Y

G0151

 

 

Minutes

15

N

G0152

 

 

Minutes

15

N

S9128

 

 

Visit

1

Y

S9129

 

 

Visit

1

Y

S9131

 

 

Visit

1

Y

1 Please see section for Primary and Add-On Service Codes

2 Per Diem Units are always billed as a single unit with a maximum of 1 unit per day.

3 For Horizon and Amerigroup, there are no validations on Modifiers, up to 4 modifiers are allowed for Amerigroup.  Up to 2 modifiers will be passed to Horizon. For Horizon, providers should ensure that Modifiers match what has been claimed to Horizon. For Amerigroup, even if no modifiers are listed in the table above, all modifiers are allowable to be included on visit data.

4 AuthRefNumbers are required for all Procedure Codes for Amerigroup New Jersey.


Member Attestation Codes

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


Manual Reasons Codes

Code Description

MR2200

Phone number did not link to the Member

MR2201

Member won't let attendant use phone

MR2202

Member doesn't have a phone in home

MR2203

Phone in use by Member or individual in Member's home

MR2204

Member received services outside of the home

MR2205

Member's phone line not working (technical issue or natural disaster)

MR2206

Member requested to change/cancel scheduled visit; or the scheduled visit has been cancelled due to the Member’s services being suspended

MR2207

Address did not link to the Member (GPS)

MR2208

Attendant failed to call in

MR2209

Attendant failed to call out

MR2210

Attendant failed to call in and out

MR2211

Attendant called in to or out of the EVV system early or late

MR2212

Attendant's identification number(s) does not match the scheduled shift or task discrepancy/task does not match plan of care

MR2213

Attendant entered invalid fixed location device code(s)

MR2214

Attendant failed to report to Member’s home

MR2215

Fixed location device on order or pending placement in the home

MR2216

Fixed location device malfunctioned

MR2217

Attendant unable to use mobile device

MR2218

Attendant unable to connect to internet or EVV system down

MR2219

Data Entry Error

MR2220

Agency unable to provide replacement coverage (no show, no replacement)

MR2221

Timesheet Received

MR2222

Other


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 MCO member services
LA1020 Caregiver checked in late


Missed Reasons Codes

Code Description

MVR2600

Agency unable to provide replacement coverage (no show, no replacement)

MVR2601

Attendant failed to report to Member’s home

MVR2602

Member requested to change/cancel scheduled visit; or the scheduled visit has been cancelled due to the Member’s services being suspended

MVR2603

Member Refused Service

MVR2604

Member Refused Service - original aide on vacation

MVR2605

COVID-19: All other cases where the agency could not staff due to COVID-19

MVR2606

COVID-19: Member refused, receiving service through informal supports

MVR2607

COVID-19: Member refused, self-isolating, not receiving service

MVR2608

Hospitalization unplanned

MVR2609

Other


Missed Visit Actions Taken Codes

Code Description

MVA1051

Confirmed with the Member or the Member’s family member/representative and documented

MVA1052

New attendant assigned to Member

MVA1053

Other

MVA1054

Service(s) cancelled or suspended until further notice

MVA1055

Unverified visit

MVA1056

Visit rescheduled

 

MCOID Codes* 

Code Description
NJ_AGP Amerigroup New Jersey
NJ_HZ Horizon New Jersey Health

 

Primary and Add On Service Codes

  • Primary/Add On Service Codes (99601/99602 and 97129/97130) are service codes that have explicit divisions required for billing purposes. These services do not need to be divided from an EVV perspective. For example, if three hours of infusion services are provided, then first two hours are billed under 99601 and the last hour should be billed under 99602.

Amerigroup New Jersey

  • The examples and rules below utilize 99601/99602, but identical logic applies for 97129/97130 (with the relevant unit type being per 15 mins rather than hourly).
  • Providers must have both primary and add-on service codes authorized in order for billing to function correctly in all cases. If only one of the primary or add-on service code is authorized, the provider should reach out to Amerigroup New Jersey.
  • From an EVV data perspective, it would be acceptable to send the entire visit using 99601. If the visit is longer than two hours, when the claim is generated, CareBridge will automatically apply the following rules:

Example 1 - Single Visit, More than 2 Hours

Rule: Claims for 99601/99602 for each billing provider/member/authorization, will be billed as separate claim lines on the same claim.

ApptID Checkout Date Checkout Time Checkout Date Checkout Time Procedure Code in Visit File   Claim # Claim DOS Claim Line Procedure Code Units Claim Line #
1000 8/1/2022 9:00 AM 8/1/2022 1:00 PM 99601   100 8/1/2022 99601 1 100
                  99602 2 200


Example 2 - Single Visit, Less than 2 hours

Rule: If only one visit is received for a calendar day (for each billing provider/member/authorization), the first two hours will be billed under 99601 and any additional hours will be billed as 99602.

ApptID Checkout Date Checkout Time Checkout Date Checkout Time Procedure Code in Visit File   Claim # Claim DOS Claim Line Procedure Code Units Claim Line #
1001 8/2/2022 9:00 AM 8/2/2022 10:00 AM 99601   102 8/2/2022 99601 1 101

 

Example 3 - Multiple Visits, Initial Visit Less than 2 hours

Rule: If multiple visits are received for a calendar day, and the first visit is less than two hours, then that visit will be billed under 99601 and the additional visits will be billed under 99602 with units rounding up for each hour.

ApptID Checkout Date Checkout Time Checkout Date Checkout Time Procedure Code in Visit File   Claim # Claim DOS Claim Line Procedure Code Units Claim Line #
1002 8/3/2022 9:00 AM 8/3/2022 10:00 AM 99601   103 8/3/2022 99601 1 102
1003 8/3/2022 1:00 PM 8/3/2022 2:00 PM 99601       99602 1 201

 

Example 4 - Multiple Visits, Initial Visit more than 2 Hours

Rule: If multiple visits are received for a calendar day, and the first visit is longer than two hours, then the first two hours of that visit will be billed under 99601 and the remaining duration of that visit will be combined with any additional visits and the total additional duration will be billed under 99602 with units rounding up for each hour.

ApptID Checkout Date Checkout Time Checkout Date Checkout Time Procedure Code in Visit File   Claim # Claim DOS Claim Line Procedure Code Units Claim Line #
1004 8/4/2022 9:00 AM 8/4/2022 1:30 PM 99601   104 8/4/2022 99601 1 103
1005 8/4/2022 2:30 PM 8/4/2022 3:30 PM 99601       99602 4 202

 

Example 5 - Single Visit, Overnight

Rule: If a visit spans midnight, then the logic above will be applied, but all of the units will be billed on the initial date of service. This ensures that 99602 is not billed separately from 99601.

ApptID Checkout Date Checkout Time Checkout Date Checkout Time Procedure Code in Visit File   Claim # Claim DOS Claim Line Procedure Code Units Claim Line #
1006 8/5/2022 9:00 PM 8/6/2022 1:00 AM 99601   105 8/5/2022 99601 1 100
                  99602 2 200

 

Horizon

  • Visits for Primary and Add-On service codes for Horizon members should be sent to CareBridge in accordance with the way that they are claimed to Horizon.

 

Pre-Billing Validations

Pre-billing checks are performed in the CareBridge system to ensure that clean claims are generated and that EVV Data is valid.  If validation errors are present in response files or appointment error files, they must be resolved by the agency or vendor prior to claim generation.

 

A full list of CareBridge Pre-Billing Validations can be found under Technical Specifications for Third-Party Vendors > Pre-Billing Validations

 

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