Pre-Billing Validations

 

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CareBridge EVV Integration - Pre-Billing Validations

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 to the vendor that submitted the visit to CareBridge.  The table below includes a comprehensive list of CareBridge Pre-Billing validation responses - some may not be applicable to your specific integration.  

 

Error Code Entity Type Description

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

Manual Reason is not valid

VCR1051

appointment

Late Reason is not valid

VCR1052

appointment

Late Action is not valid

VCR1053

appointment

Missed Reason is not valid

VCR1054

appointment

Missed Action is not valid

VCR1055

appointment

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

VCR1093

appointment

Invalid member medicaid id

VCR1094

appointment

Completed visit requires member attestation

VCR1095

appointment

Appointment start after end

VCR1096

appointment

Appointment EVV checkin after checkout

VCR1097

appointment

Appointment manual checkin after checkout

VCR1098

appointment

Caregiver Atypical Id

VCR1099

appointment

Diagnosis Code must be valid ICD10 code

VCR1100

appointment

NPI does not exist on appointment

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

VCR2059

appointment

Missing provider medicaid id

VCR2060

appointment

Provider must have either NPI or API

VCR2061

appointment

Members 21 and older must have U3 modifier. Those under 21 must not.

VCR2062

appointment

Rate exceeds max allowable rate.

VCR2063

appointment

Survey question external codes must be valid.

VCR2064

appointment

Care task external codes must be valid.

VCR2065

appointment

For procedure code 99509, members 21 and older must have HB modifier. Those under 21 must have a HA modifier.

VCR2066

appointment

The most recent claim request has failed. View claim history for more information

VCR2067

appointment

Payer does not support sending voided claims.

VCR2068

appointment

Member is not present in the payer's membership file

VCR2069 appointment Appointment cannot be billed outside of the active claim window
VCR2070 appointment Appointment overlaps with other scheduled appointments and does not appear to be a valid group visit.
VCR2071 appointment Payer does not support voiding externally.
VCR2072 appointment Missing employee on appointment
VCR2073 appointment Visit contains invalid survey responses.
VCR2074 appointment Tax id on appointment does not match the tax id on the provider.
VCR2075 appointment Procedure code is not a valid code for this payer.
VCR2076 appointment Appointment can not cross midnight.
VCR2077 appointment Provider State Registration is missing.
VCR2078 appointment Provider is not active according to the state roster.
VCR2079 appointment Visit does not meet the duration requirements for the service code.
VCR2080 appointment Overnight appointments are not allowed.
VCR2081 appointment Revenue code is missing or is not a valid code for this payer.
VCR2082 appointment Visit location type is required for home health services.
C1001 claim Taxonomy Code is required.

C2001

claim

Claim could not be rolled up due to in flight claims

C2002

claim

Appointment has 0 units to bill

C2003

claim

Claim is not balanced

CG1001

caregiver

Caregiver First Name

CG1002

caregiver

Caregiver Last Name

CG1003

caregiver

Caregiver License Number

CG1004

caregiver

Employee Id is not valid.

CG1005

caregiver

Caregiver hire date

CG1006

caregiver

Caregiver type

CG1007

caregiver

Caregiver gender

CG1008

caregiver

Caregiver date of birth

CG1009

caregiver

Caregiver Medicaid Id

CG1010

caregiver

Caregiver Atypical Id

CG1011 caregiver Employee Zip is missing or invalid.

CG1012

caregiver

Employee SSN is missing or invalid.

G1000

NULL

Generic Error

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

M1014

member

Eligibility end is in the past

M1015

member

Invalid member medicaid id

M2001

member

Member not associated to an auth

M2002

member

Date Of Birth is in the future

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

P1013

provider

Npi

P1014

provider

Provider end date is in the past

P1015

provider

Invalid npi

P1017

provider

Medicaid Id

P1018

provider

Provider has a PO Box address

P1019

provider

Zip

P2001

provider

Individual CDAC providers must have a medicaid id.

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

A1014

authorization

Authorization end date is in the past.

A1015

authorization

Attending Provider Name

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

A2014

authorization

Authorization has multiple lines with different hcpc and modifier combinations in the same file.

A2017

authorization

Invalid npi

A2018

authorization

Members 21 and older must have U3 modifier. Those under 21 must not.

A2019

authorization

Rate exceeds max allowable rate.

A2020

authorization

Diagnosis Code must be valid ICD10 code

A2021

authorization

Rate is missing

A2022

authorization

Invalid service type for member over 21
A2023

authorization

Service code is not in the list of authorized services.
A2025

authorization

Attending Provider NPI does not meet requirements for a valid NPI.
A2024

authorization

Attending Provider must have either NPI or AltID.
A2026

authorization

Provider Secondary ID required for procedure code.
A2027

authorization

An authorization for a corresponding service does not exist.
A2028

authorization

Auth limit type is not allowed.