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 data aggregation purposes. If you have questions at any point, our team is here to help: evvintegration@carebridgehealth.com. A PDF of this guide is available here.

WHAT IS CAREBRIDGE?

CareBridge is a company formed to enable 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 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_IA_ProviderTaxID_YYYYMMDDHHMMSS.CSV

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

CareBridge Response File

VISITS_IA_ProviderTaxID_ERROR_YYYYMMDDHHMMSS.txt

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

TEST_VISITS_IA_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 and is sending production data, 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: Iowa - 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 > Iowa - 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 successfully 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.

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.  Prior to sending any data, Provider Agencies should complete the following form here to have their Tax ID Associated with the appropriate vendor within the CareBridge System.  If this is not completed, data from your Third-Party Vendor system will not be loaded.  This must be done for each Tax ID.

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

1. Send a file in the production environment with actual visit/appointment data.
   1. Only sending 1-5 rows of data initially.
   2. Sending visit data with the ClaimAction field as null.
   3. 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, 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. Pre-Billing Validation Report in addition to response files to ensure providers have the most up-to-date information regarding outstanding visit errors.
     2. 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 the 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

^{* *See Claim Element Technical Details for additional information.}

PCS Service Codes Unit Definitions

^{1  S5150 is an optional service code that is only applicable for Wellpoint Iowa.}

Home Health Service Codes and Unit Definitions (Phase 1)¹

^{1 Phase 1 Services will always have prior authorizations and therefore, will always require the AuthRefNumber field to be populated.}

^{2 After Phase 2 System Availability, 10/1/2023, these Service Codes will require the IsWaiver field to be populated with “Yes” if performed under the Waiver program and “No” if performed as Non-Waiver services}

Home Health Service Codes and Unit Definitions (Phase 2) - Wellpoint Iowa

Home Health Service Codes and Unit Definitions (Phase 2) - Iowa Total Care²

^{1 These Service Codes require the IsWaiver field to be populated with “Yes” if performed under the Waiver program and “No” if performed as Non-Waiver services}

^{2 All Iowa Total Care Home Health Phase 2 Service Codes are "Never" Prior Authorized for Dates of Service on or before 12/31/2024.}

Home Health Service Codes and Unit Definitions (Phase 2) - Molina Healthcare of Iowa

^{1 These Service Codes require the IsWaiver field to be populated with “Yes” if performed under the Waiver program and “No” if performed as Non-Waiver services}

Prior Authorization Requirements

• “Always” authorized procedure codes in the tables above require the AuthRefNumber field to be populated for all visits.
• “Sometimes” authorized procedure codes will require the AuthRefNumber field to be populated if an authorization has been issued.  If an authorization has not been issued, but a valid EVV Visit occurs for a member, this field should be left null.
• “Never” authorized procedure codes require that the AuthRefNumber field be left null for all EVV Visits.

Member Attestation Codes

Manual Reasons Codes

Late Reasons Codes

Late Reason Actions Taken Codes

Missed Reasons Codes

Missed Visit Actions Taken Codes

MCOID Codes

Facility Type Codes

Initial Claim Frequency Codes

Patient Status Codes

Condition Codes

Value Codes

Care Plan Task Codes

Procedure Codes to Care Plan Task Codes

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 Validation Errors