Wyoming

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CareBridge EVV Integration Guide and Technical Specifications

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 version of this document 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 state.

All EVV Visit and Claims data must ultimately be reflected in the CareBridge Platform for state 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.
    • Provider takes action on response errors and resubmits visits.
      • It is the responsibility of the Third-Party EVV Vendor to ensure providers can correct errors within their EVV system and are able to resubmit the corrected visits to CareBridge.
      • CareBridge provides daily reports on outstanding pre-billing errors via the supplemental
        Pre-Billing Validation Report
        .
  4. CareBridge utilizes visits data to generate claims and submits to clearinghouse / state.
  5. CareBridge provides daily updates on visit status via the supplemental Appointment Status Report.
  6. Providers can continue to receive claim remittances through previously established mechanisms (Availity).

The supplemental report specifications can be found on the CareBridge EVV Data Integration web page: http://evvintegration.carebridgehealth.com, under Additional Documents for Third-Party Vendors.

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

Do not continue to re-send appointments / visits that have not changed unless instructed by CareBridge. If a visit has been sent with ClaimAction 'N', do not re-submit until it reaches a terminal status (Rejected, Paid, Denied), or an error was included for that visit in the CareBridge Response File.

 

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.
  • 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_WY_ProviderTaxID_YYYYMMDDHHMMSS.CSV


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

Note: The state initials are required for files to be processed.

CareBridge Response File

VISITS_WY_ProviderTaxID_ERROR_YYYYMMDDHHMMSS.txt

 

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

TEST_VISITS_WY_ProviderTaxID_ERROR_YYYYMMDDHHMMSS.txt

 

TESTING INSTRUCTIONS

Testing Overview 

Vendors are required to complete testing scenarios in order to begin sending production data to CareBridge.

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: Wyoming - 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 > Wyoming - Third-Party EVV Vendor Integration Testing Process Guide. 

Note: the Wyoming - Third-Party EVV Vendor Integration Testing Process Guide will be available soon.

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 file specifications.
  • Data Validation Testing– Vendors are able to send records in accordance with data specifications.  A full list of CareBridge Pre-Billing Validations can be found under Technical Specifications for Third-Party Vendors > Pre-Billing Validation Errors


Initial Production Data Go-Live

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 sending 1-5 rows of data initially.
    b. Sending visit data with the ClaimAction field as null.
    c. At least one row of data 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.

  • 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 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

1

VendorName 

Name of EVV vendor sending data

Alphanumeric

Y

Y

EVV Vendor

 

2

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

 

3

TransactionDateTime 

Time stamp associated with the visit data being sent to CareBridge

Datetime

Y

Y

YYYY-MM-DDTHH:MM:SSZ
“2020-01-01T14:00:00Z”

 

4

ProviderName 

Name of provider 

Alphanumeric

Y

Y

Home Health, LLC

255

5

ProviderID 

Unique identifier for the provider
(in Third-party EVV system)

Alphanumeric

Y

Y

43134

35

6

ProviderNPI 

NPI of provider

Numeric

Y
(required unless the provider is atypical)

Y
(required unless the provider is atypical)

1609927680

10

7

ProviderEIN 

Tax ID or EIN of provider

Alphanumeric

Y

Y

208076837

10

8

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 

UniqueID assigned to caregiver by Provider Agency (Employee ID) 

Alphanumeric

Y

Y

982123

 

13

MemberFName 

First name of member

Alphanumeric

Y

Y

Jane

 

14

MemberLName 

Last name of member

Alphanumeric

Y

Y

Johnson

 

15

MemberMedicaidID

Medicaid ID for member  

Alphanumeric

Y

Y

362714245

 

16

MemberID

Member ID in Vendor System

Alphanumeric

N

N

362714245

 

17

MemberDateOfBirth

Date of birth of member

Alphanumeric

N

N

YYYY-MM-DD

 

18

ApptStartDateTime

Date / Time that the appointment was scheduled to begin

DateTime

Y

Y

YYYY-MM-DDTHH:MM:SSZ
“2020-01-01T14:00:00Z”

 

19

ApptEndDateTime

Date / Time that the appointment was scheduled to end

DateTime

Y

Y

YYYY-MM-DDTHH:MM:SSZ
“2020-01-01T14:00:00Z”

 

20

ApptCancelled

(C) if appointment was cancelled

Alphanumeric

N

N

C

 

22

CheckInDateTime 

Date / Time that the visit was checked into in UTC

Datetime

N

Y

YYYY-MM-DDTHH:MM:SSZ
“2020-01-01T14:00:00Z”

 

23

CheckInMethod

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

Alphanumeric

N

Y

E

 

24

CheckInStreetAddress

Street address where check in occurred

Alphanumeric

N

Y

123 Main St

 

25

CheckInStreetAddress2

Additional street address info where check in occurred

Alphanumeric

N

Y

Suite B

 

26

CheckInCity

City where check in occurred 

Alphanumeric

N

Y

Jackson

 

27

CheckInState

State where check in occurred  

Alphanumeric

N

Y

WY

 

28

CheckInZip

Zip code where check in occurred

Alphanumeric

N

Y

83002

 

29

CheckInLat

Latitude of coordinates where check in occurred

Alphanumeric

N

Y, if
CheckInMethod = E

##.######

 

30

CheckInLong

Longitude of coordinates where check in occurred 

Alphanumeric

N

Y, if
CheckInMethod = E

###.######

 

31

CheckOutDateTime

Date / Time that the visit was checked out in UTC

Datetime

N

Y

YYYY-MM-DDTHH:MM:SSZ
“2020-01-01T14:00:00Z”

 

32

CheckOutMethod

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

Alphanumeric

N

Y

E

 

33

CheckOutStreetAddress

Address where check out occurred

Alphanumeric

N

Y

123 Main St

 

34

CheckOutStreetAddress2

Additional address info where check out occurred

Alphanumeric

N

Y

Suite B

 

35

CheckOutCity

City where check out occurred

Alphanumeric

N

Y

Jackson

 

36

CheckOutState

State where check out occurred

Alphanumeric

N

Y

WY

 

37

CheckOutZip

Zip code where check out occurred 

Alphanumeric

N

Y

83002

 

38

CheckOutLat

Latitude of coordinates where check out occurred

Alphanumeric

N

Y, if
CheckOutMethod = E

##.######

 

39

CheckOutLong

Longitude of coordinates where check out occurred 

Alphanumeric

N

Y, if
CheckOutMethod = E

###.######

 

40

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

S5135
See Rate & Unit Definitions table

 

43

Modifier 1 

Modifier code for services rendered during visit

Alphanumeric

N

N

TT

 

44

Modifier 2

Second modifier code for services rendered during visit  

Alphanumeric

N

N

HQ

 

45

Modifier 3

Third modifier code for services rendered during visit  

Alphanumeric

N

N

HA

 

46

Modifier 4

Fourth modifier code for services rendered during visit  

Alphanumeric

N

N

U2

 

47

TimeZone

Time zone that the visit took place in  

Alphanumeric

Y

Y

US/Mountain

 

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
CheckOutMethod = 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

N

I50.9

 

52

ApptAttestation 

Member attestation associated with the visit

Alphanumeric

N

Y

See Member Attestation Codes table

 

53

ManualReason 

Reason for manual entry associated with the visit

Alphanumeric

N

Y, if CheckInMethod or CheckOutMethod= M

See Manual Reasons Codes table

 

54

EarlyReason 

Reason the visit was late

Alphanumeric

N

Y, if check in occurred greater than or equal to 30 minutes prior to scheduled start time

See Manual Reasons Codes table

 

55

EarlyAction 

Action taken due to visit being late

Alphanumeric

N

Y, if check in occurred greater than or equal to 30 minutes prior the scheduled start time

See Manual Reasons Codes table

 

56

LateReason 

Reason the visit was late

Alphanumeric

N

Y, if check in occurred between 30 minutes  three hours after the scheduled start time

See Late Reasons Codes table

 

57

LateAction 

Action taken due to visit being late

Alphanumeric

N

Y, if check in occurred between 30 minutes  three hours after the scheduled start time

See Late Actions Codes table

 

58

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

 

59

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

 

60

CarePlanTasksCompleted

Tilda delimited list of tasks completed during the visit

Alphanumeric

N

N

CP2000~CP2015~CP2030
See Care Plan Tasks Codes

 

61

CarePlanTasksNotCompleted

Tilda delimited list of tasks not completed during the visit

Alphanumeric

N

N

CP2005~CP2020~CP2025
See Care Plan Tasks Codes

 

62

CaregiverSurveyQuestions

Tilda delimited list of survey questions presented to the caregiver

Alphanumeric

N

N

SQ1000~SQ1005
See Survey Questions Codes

 

63

CaregiverSurveyResponses

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

Alphanumeric

N

N

Yes~No

 

64

Rate

Billed unit rate associated with the visit

Decimal

N

Y, if billed

Ex 1. 5.50
Ex 2. 289.00
See Rate & Unit Definitions table

 

65

ClaimAction 

New Claim (N), Void (V)

Alphanumeric

N

Y

N

 

66

MCOID

Identifies payer 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

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 system

104

Line Item Invoice Number 2

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

 

Unit Definitions

WaiverType ServiceCode Modifier1 Unit Type Unit Quantity

CCW

S5125

 

Minutes

15

CCW

T1004

 

Minutes

15

CCW

T1002

 

Minutes

15

CCW

T1003

 

Minutes

15

CCW

S5150

 

Minutes

15

DDS/DDC

T1019

 

Minutes

15

DDS/DDC

T2027

 

Minutes

15

DDS/DDC

T2027

HA

Minutes

15

DDS/DDC

S5135

 

Minutes

15

DDS/DDC

S5135

TT

Minutes

15

DDS/DDC

T1005

 

Minutes

15

DDS/DDC

T1005

HQ

Minutes

15

DDS/DDC

S5151

 

Minutes

15

DDS/DDC

S5151

U8

Visit

1

DDS/DDC

T1002

 

Visit

1

 


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/out
MR1025 Missing/waiting for authorization


Early Reasons Codes

Code Description
ER1000 Caregiver forgot to check in
ER1005 Technical issue
ER1010 Member rescheduled


Early Visit Actions Taken Codes

Code Description
EA1000 Rescheduled
EA1005 Back-up plan initiated
EA1010 Contacted service coordinator
EA1015 Contacted member services
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 Visit Actions Taken Codes

Code Description
LA1000 Rescheduled
LA1005 Back-up plan initiated
LA1010 Contacted service coordinator
LA1015 Contacted 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 member services
MVA1020 Service provided as scheduled


MCOID Codes

Code Description
WY_DOH Wyoming Department of Health


Care Plan Tasks

Note: Care Plan Tasks are restricted by Procedure Code as indicated in the Procedure Code to Care Plan Tasks section.  Care Plan Tasks that are not included in the mapping for a given procedure code are not valid for that procedure code.

Code Description

CP2000

Bathing

CP2005

Bathing, grooming, personal hygiene

CP2010

Communication

CP2011

Community integration

CP2015

Dressing

CP2020

Eating

CP2025

Assist w/ Essential housekeeping

CP2030

Essential transportation

CP2035

Financial and scheduling assistance

CP2040

Functional Mobility

CP2045

Grooming: Nail Care

CP2050

Grooming: Oral Care

CP2055

Grooming: Shaving/Applying Makeup

CP2060

Grooming: Skin Care

CP2065

Light housekeeping

CP2070

Meal Preparation

 

 

CP2075

Meal preparation and feeding

CP2080

Medication assistance

CP2085

Minor wound care

CP2090

Shopping

CP2091

Skill development

 

 

CP2095

Skilled Care: Bathing

CP2100

Skilled Care: Eating

CP2105

Skilled Care: Mobility

CP2110

Skilled Care: Toileting

CP2115

Skilled Nail Care

CP2120

Skilled Nursing Care

CP2125

Skilled Oral Care

CP2130

Skilled Skin Care

CP2131

Socialization

CP2135

Toileting

CP2140

Transferring, ambulation, mobility

CP2145

Light Housework

CP2150

Laundry

CP2155

Physical health maintenance

 

Procedure Code to Care Plan Tasks

Procedure Code Care Plan Task Code   Procedure Code Care Plan Task Code   Procedure Code Care Plan Task Code
T1002 CP2100 T1019 CP2015 S5151 CP2015
CP2095 CP2005 CP2005
CP2125 CP2075 CP2075
CP2115 CP2135 CP2135
CP2130 CP2140 CP2140
CP2110 CP2035 CP2085
CP2105 CP2080 CP2030
CP2080 CP2145 CP2080
CP2085 CP2150 S5125 CP2020
CP2120 T2027 CP2015 CP2000
T1003 CP2100 CP2005 CP2015
CP2095 CP2075 CP2045
CP2125 CP2135 CP2050
CP2115 CP2010 CP2055
CP2130 CP2030 CP2060
CP2110 CP2080 CP2135
CP2105 CP2091 CP2040
CP2080 CP2131 CP2065
CP2085 CP2011 CP2090
CP2120 CP2155 CP2070
T1004 CP2020 S5135 CP2005 S5150 CP2020
CP2000 CP2025 CP2000
CP2015 CP2035 CP2015
CP2050 CP2010 CP2045
CP2045 CP2030 CP2050
CP2060 CP2080 CP2055
CP2055 CP2092 CP2060
CP2135 CP2071 CP2135
CP2040 CP2131 CP2040
CP2065 CP2011 CP2065
CP2090 T1005 CP2015 CP2090
CP2070 CP2005 CP2070
  CP2075  
CP2135
CP2140
CP2085
CP2030
CP2080

Survey/Observed Changes Question

Code Task Description

SQ1000

Did the member's health or illness worsen since your last visit?

SQ1005

Did you notice or were you told about any safety risks in the home today?

SQ1010

Does the member have any problems taking their medication?

SQ1015

Has the member been admitted to the hospital or emergency room since the last visit?

SQ1020

Has the member fallen since the last visit?

SQ1025

Is the member looking or acting different than they usually do?

 

Pre-Billing Validation

Pre-billing checks are performed in the CareBridge system to ensure that clean claims are generated.  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

Have more questions? Submit a request