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 PHPs.

All EVV Visit and Claims data must ultimately be reflected in the CareBridge Platform for PHP receipt, payment, and monitoring. Note: Third-Party Vendors will be responsible for aggregating their encounters data to the state aggregator (Sandata).  CareBridge will pass the necessary EVV_Key in the appointment status report.

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 / PHPs.
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_NC_ProviderTaxID_YYYYMMDDHHMMSS.CSV

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

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

CareBridge Response File

VISITS_NC_ProviderTaxID_ERROR_YYYYMMDDHHMMSS.txt

 

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

TEST_VISITS_NC_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: North Carolina - 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 > North Carolina - 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 file specifications.
• Data Validation Testing– Vendors are able to send records in accordance with data specifications.

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. 1. 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.
              • • 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.
   • 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

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

 
Appointments / Visits Data File Format

PCS Service Codes and Unit Definitions

 

Home Health Service Codes and Unit Definitions

Service Code	Revenue Code	Revenue Code Description	Auth Required	Unit Type	Unit Quantity
92521	0444	Speech Therapy - Evaluation	Sometimes	Visit Per Day*	1
92522	0444	Speech Therapy - Evaluation	Sometimes	Visit Per Day	1
92523	0444	Speech Therapy - Evaluation	Sometimes	Visit Per Day	1
97161	0424	Physical Therapy - Evaluation	Sometimes	Visit Per Day	1
97162	0424	Physical Therapy - Evaluation	Sometimes	Visit Per Day	1
97163	0424	Physical Therapy - Evaluation	Sometimes	Visit Per Day	1
97164	0424	Physical Therapy - Evaluation	Yes	Visit Per Day	1
97165	0434	Occupational Therapy - Evaluation	Sometimes	Visit Per Day	1
97166	0434	Occupational Therapy - Evaluation	Sometimes	Visit Per Day	1
97167	0434	Occupational Therapy - Evaluation	Sometimes	Visit Per Day	1
97168	0434	Occupational Therapy - Evaluation	Yes	Visit Per Day	1
G0151	0420	Physical Therapy	Yes	Visit Per Day	1
G0152	0430	Occupational Therapy	Yes	Visit Per Day	1
G0153	0440	Speech Therapy	Yes	Visit Per Day	1
G0156	0570	Home Health Aide Visit	Sometimes	Visit Per Day	1
G0157	0420	Physical Therapy	Yes	Visit Per Day	1
G0158	0434	Occupational Therapy - Evaluation	Yes	Visit Per Day	1
G0159	0420	Physical Therapy	Yes	Visit Per Day	1
	0424	Physical Therapy - Evaluation		Visit Per Day	1
G0160	0430	Occupational Therapy	Yes	Visit Per Day	1
	0434	Occupational Therapy - Evaluation		Visit Per Day	1
G0161	0440	Speech Therapy	Yes	Visit Per Day	1
G0162	0550	Skilled nursing: Initial assessment/re- assessment	Yes	Visit Per Day	1
G0283	0420	Physical Therapy	Yes	Visit Per Day	1
G0299	0551	Skilled nursing: Treatment, teaching/training, observation/evaluation	Yes	Visit Per Day	1
	0559	Skilled nursing: For a dually eligible beneficiary when the visit does not meet Medicare criteria		Visit Per Day	1
	0580	Skilled nursing: venipuncture		Visit Per Day	1
	0581	Skilled nursing: Pre- filling insulin syringes/Medi- Planners		Visit Per Day	1
G0300	0551	Skilled nursing: Treatment, teaching/training, observation/evaluation	Yes	Visit Per Day	1
	0559	Skilled nursing: For a dually eligible beneficiary when the visit does not meet Medicare criteria		Visit Per Day	1
	0580	Skilled nursing: venipuncture		Visit Per Day	1
	0581	Skilled nursing: Pre- filling insulin syringes/Medi- Planners		Visit Per Day	1
G0493	0550	Skilled nursing: Initial assessment/re- assessment	Sometimes	Visit Per Day	1
G0494	0550	Skilled nursing: Initial assessment/re- assessment	Sometimes	Visit Per Day	1
G0495	0551	Skilled nursing: Treatment, teaching/training, observation/evaluation	Sometimes	Visit Per Day	1
	0559	Skilled nursing: For a dually eligible beneficiary when the visit does not meet Medicare criteria		Visit Per Day	1
G2168	0420	Physical Therapy	Yes	Visit Per Day	1
G2169	0430	Occupational Therapy	Yes	Visit Per Day	1
S9122	0570	Home Health Aide Visit	Yes	Visit Per Day	1
S9123	0551	Skilled nursing: Treatment, teaching/training, observation/evaluation	Yes	Visit Per Day	1
	0559	Skilled nursing: For a dually eligible beneficiary when the visit does not meet Medicare criteria		Visit Per Day	1
S9124	0551	Skilled nursing: Treatment, teaching/training, observation/evaluation	Yes	Visit Per Day	1
	0559	Skilled nursing: For a dually eligible beneficiary when the visit does not meet Medicare criteria		Visit Per Day	1
	0580	Skilled nursing: venipuncture		Visit Per Day	1
	0581	Skilled nursing: Pre- filling insulin syringes/Medi- Planners		Visit Per Day	1
S9128	0440	Speech Therapy	Yes	Visit Per Day	1
S9129	0430	Occupational Therapy	Yes	Visit Per Day	1
S9131	0420	Physical Therapy	Yes	Visit Per Day	1
T1002	0551	Skilled nursing: Treatment, teaching/training, observation/evaluation	Yes	Visit Per Day	1
	0559	Skilled nursing: For a dually eligible beneficiary when the visit does not meet Medicare criteria		Visit Per Day	1
T1021	0570	Home Health Aide Visit	Sometimes	Visit Per Day	1
T1030	0551	Nursing Care, In The Home, By Registered Nurse	Yes	Visit Per Day	1

* Visit Per Day - defined as 1 visit corresponds to 1 billed unit for each date of service within which the visit occurs

Member Attestation Codes

Manual Reasons Codes

Late Reasons Codes

Late Visit Actions Taken Codes

 
Missed Reasons Codes

Missed Visit Actions Taken Codes

 

Visit Location Type Codes

Code	Description
1	Home
2	Community

MCOID Codes

 

Care Plan Tasks

 

Survey/Observed Changes Question

Pre-Billing Validation

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