(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_AR_ProviderTaxID_YYYYMMDDHHMMSS.CSV
For Test Files, “TEST” will prepend the file name as follows:
TEST_VISITS_AR_ProviderTaxID_YYYYMMDDHHMMSS.CSV
Note: The state initials are required for files to be processed.
CareBridge Response File
VISITS_AR_ProviderTaxID_ERROR_YYYYMMDDHHMMSS.txt
For Test Files, “TEST” will prepend the file name as follows:
TEST_VISITS_AR_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: Arkansas - 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 > Arkansas - 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:
- Send a file in the production environment with actual visit/appointment data.
- Only sending 1-5 rows of data initially.
- Sending visit data with the ClaimAction field as null.
- At least one row of data be visit data rather than appointment data.
- Download the response file in the /output folder and review the pre-billing errors.
- Update data to remedy those errors; email evvintegration@carebridgehealth.com with questions about specific errors.
- 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.
- 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:
- Direct providers using your system to the CareBridge Integration Document for Providers site. It contains instructions for their expectations and next steps.
- Identify a go-live date with each agency to begin sending all data and communicate that date to CareBridge.
- 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:
- Pre-Billing Validation Report in addition to response files to ensure providers have the most up-to-date information regarding outstanding visit errors.
- 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 the 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 |
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 |
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-DD HH:MM “2020-01-01 14:00” |
|
4 |
ProviderID |
Unique identifier for the provider |
Alphanumeric |
Y |
Y |
43134 |
100 |
5 |
ProviderName |
Name of provider |
Alphanumeric |
Y |
Y |
Home Health, LLC |
255 |
6 |
ProviderNPI |
NPI of provider |
Numeric |
Y |
Y |
1609927608 |
10 |
7 |
ProviderEIN |
Tax ID or EIN of provider |
Alphanumeric |
Y |
Y |
208076837
|
9 |
8 |
ProviderMedicaidID |
MedicaidID number for Provider |
Alphanumeric |
Y |
Y |
982123567 |
9 |
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 |
Unique ID Assigned to caregiver (Employee ID) |
Alphanumeric |
Y |
Y |
982123 |
|
13 |
CaregiverLicenseNumber |
License number for caregiver |
Alphanumeric |
N |
N |
22AA88888888 |
12 |
14 |
CaregiverMedicaidID* |
MedicaidID number for caregiver |
Alphanumeric
|
Y |
Y |
982123567 |
9 |
15 |
MemberFName |
First name of member |
Alphanumeric |
Y |
Y |
Jane |
|
16 |
MemberLName |
Last name of member |
Alphanumeric |
Y |
Y |
Johnson |
|
17 |
MemberDateOfBirth |
Date of birth of member |
Alphanumeric |
N |
N |
YYYY-MM-DD |
|
18 |
MemberMedicaidID |
Medicaid ID for member - 10 digits |
Numeric |
Y |
Y |
3627142405 |
10 |
19 |
MemberID |
If not using Medicaid ID |
Alphanumeric |
N |
N |
47138493 |
|
20 |
ApptStartDateTime |
Date / Time that the appointment was scheduled to begin |
DateTime |
Y |
N |
YYYY-MM-DD HH:MM “2020-01-01 14:00” |
|
21 |
ApptEndDateTime |
Date / Time that the appointment was scheduled to end |
DateTime |
Y |
N |
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 |
##.###### |
|
31 |
CheckInLong |
Longitude of coordinates where check in occurred |
Alphanumeric |
N |
Y |
###.###### |
|
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 |
##.###### |
|
40 |
CheckOutLong |
Longitude of coordinates where check out occurred |
Alphanumeric |
N
|
Y |
###.###### |
|
41 |
CheckinDistance |
Distance from visit location (miles) |
Decimal |
N |
Y |
0.125 |
|
42 |
CheckoutDistance |
Distance from visit location (miles) |
Decimal |
N |
Y |
0.125 |
|
43 |
CheckinLocationReason |
Reason check in was outside of 1/8 mile geofence |
Alphanumeric |
N |
Y |
See Check in/out Location Codes table below |
|
44 |
CheckoutLocationReason |
Reason check out was outside of 1/8 mile geofence |
Alphanumeric |
N |
Y |
See Check in/out Location Reasons Codes table below |
|
45 |
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 |
S5125 |
|
46 |
Modifier 1 |
Modifier code for services rendered during visit |
Alphanumeric |
N |
N |
U5 |
|
47 |
Modifier 2 |
Second modifier code for services rendered during visit |
Alphanumeric |
N |
N |
UA |
|
48 |
TimeZone |
Time zone that the visit took place in |
Alphanumeric |
Y |
Y |
US/Eastern |
|
49 |
CheckInIVRPhoneNumber |
Phone Number used to check in |
Alphanumeric |
N |
Y |
+14156665555 |
|
50 |
CheckOutIVRPhoneNumber |
Phone Number used to check out |
Alphanumeric |
N |
Y |
+14156665555 |
|
51 |
ApptNote |
Free text note related to the visit |
Alphanumeric |
N |
N |
Scheduling related note |
|
52 |
DiagnosisCode |
Tilde delimited list of ICD-10 Diagnosis code attributed to the visit. (Enter in the order that they are billed and primary dx should be the first listed.) |
Alphanumeric |
N |
Y, up to 23 allowed for Home Health Services |
I50.9~R68.89
|
|
53 |
ApptAttestation |
Member attestation associated with the visit |
Alphanumeric |
N |
Y |
See Member Attestation Codes table below |
|
54 |
Rate |
Billed unit rate associated with the visit |
Decimal |
Y |
Y |
3.85 |
|
55 |
ManualReason |
Reason for manual entry associated with the visit |
Alphanumeric |
N |
Y |
See Manual Reasons Codes table below |
|
56 |
EarlyReason |
Reason the visit was early |
Alphanumeric |
N |
N |
See Early Reasons Codes table below |
|
57 |
EarlyAction |
Action taken due to visit being early |
Alphanumeric |
N |
N |
See Early Actions Codes table below |
|
58 |
LateReason |
Reason the visit was late |
Alphanumeric |
N |
N |
See Late Reasons Codes table below |
|
59 |
LateAction |
Action taken due to visit being late |
Alphanumeric |
N |
N |
See Late Actions Codes table below |
|
60 |
MissedReason |
Reason the visit was missed |
Alphanumeric |
N |
N |
See Missed Reasons Codes table below |
|
61 |
MissedAction |
Action taken due to the visit being missed |
Alphanumeric |
N |
N |
See Missed Actions Codes table below |
|
62 |
CarePlanTasksCompleted |
Tilde delimited list of tasks completed during the visit |
Alphanumeric |
N |
N |
Toileting~Bathing |
|
63 |
CarePlanTasksNotCompleted |
Tilde delimited list of tasks not completed during the visit |
Alphanumeric |
N |
N |
Laundry~ Trash Removal |
|
64 |
CaregiverSurveyQuestions |
Tilde 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? |
|
65 |
CaregiverSurveyResponses |
Tilde delimited list of survey responses to questions presented to the caregiver in the same order as the questions listed in field 64 |
Alphanumeric |
N |
N |
Yes~No |
|
66 |
ClaimAction |
New Claim (N), Corrected Claim (C), Void (V), Claims Billed Externally-Not Via CareBridge (E) |
Alphanumeric |
N |
Y |
N |
|
67 |
MCOID |
Identifies health plan the member is associated with |
Alphanumeric |
Y |
Y |
See MCOID table below |
|
68 |
AttendingProviderFirstName | First Name of Attending Provider that should be included on Claim | Alphanumeric | Y for Home Health Visits | Y for Home Health Visits | John |
|
69 |
AttendingProviderLastName | Last Name of Attending Provider that should be included on Claim | Alphanumeric | Y for Home Health Visits | Y for Home Health Visits | Smith |
|
70 |
AttendingProviderNPI | NPI of Attending Provider that should be included on Claim that is registered with AR DHS | Alphanumeric | Y for Home Health Visits | Y for Home Health Visits | 1234567893 |
|
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 |
||||
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 |
*For Home Health Services Caregivers must have a provider type of ‘21’ for S9131 or ‘95’ for T1021. For Personal Care Services Caregivers must have a provider type of ‘95’ for T1019.
Personal Care Service Rate & Unit Definitions
Service Code | Modifier1 | Unit Type | Unit Quantity |
T1019 | Minutes | 15 | |
T1019 | U3 | Minutes | 15 |
Home Health Service Unit Definitions
Service Code | Modifier1 | Auth Issuance Type | Unit Type | Unit Quantity |
S9131 | Always | Visit | 1 | |
S9131 | UB | Always | Visit | 1 |
T1021 | Sometimes | Visit | 1 | |
T1021 | TD | Sometimes | Visit | 1 |
T1021 | TE | Sometimes | Visit | 1 |
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.
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 |
MR1025 | Missing/waiting for authorization |
MR1050 | Member Initiated |
Check in/out Location Reasons Codes
Code | Description |
LOR1000 | Address is incorrect |
LOR1005 | Temporary Location |
LOR1010 | Other |
Early Reasons Codes
Code | Description |
ER1000 | Caregiver error |
ER1005 | Technical issue |
ER1010 | Member rescheduled |
Early Reason Actions Taken Codes
Code | Description |
EA1000 | Rescheduled |
EA1005 | Back-up plan initiated |
EA1010 | Contacted service coordinator |
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 Reason Actions Taken Codes
Code | Description |
LA1000 | Rescheduled |
LA1005 | Back-up plan initiated |
LA1010 | Contacted service coordinator |
LA1015 | Contacted PASSE 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 PASSE member services |
MVA1020 | Service provided as scheduled |
MCOID Codes
Code | Description |
AR_CAR | CareSource |
AR_SCC | Summit Community Care Arkansas |
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
Comments
Home Health Changes implemented (System availability expected 3/31):
- Added Home Health Service Code Table
- Added data expectations for CaregiverMedicaidID
- Added Fields for Home Health Services: AttendingProviderFirstName, AttendingProviderLastName, AttendingProviderNPI
- Increase acceptable number of Diagnosis Codes to 23 for Home Health Services
- Home Health agencies must choose their billing frequency of Daily, Weekly, or Monthly
- Defined Prior Authorization Issuance Type
Article is closed for comments.