Arkansas

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(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:

  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

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

VendorName 

Name of EVV vendor sending data

Alphanumeric

Y

Y

EVV Vendor

 

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

 

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”

 

ProviderID 

Unique identifier for the provider

Alphanumeric

Y

Y

43134

100

ProviderName 

Name of provider 

Alphanumeric

Y

Y

Home Health, LLC

255

ProviderNPI 

NPI of provider 

Numeric

Y
(required unless the provider is atypical)

Y
(required unless the provider is atypical)

1609927608

10

ProviderEIN 

Tax ID or EIN of provider 

Alphanumeric

Y

Y

208076837

 

9

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 

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


if CheckInMethod=E

##.######

 

31

CheckInLong 

Longitude of coordinates where check in occurred 

Alphanumeric

N


if CheckInMethod=E

###.######

 

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
if CheckOutMethod=E

##.######

 

40

CheckOutLong 

Longitude of coordinates where check out occurred 

Alphanumeric

N

 

Y
if CheckOutMethod=E

###.######

 

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
if CheckInMethod=I

+14156665555

 

50 

CheckOutIVRPhoneNumber 

Phone Number used to check out 

Alphanumeric

N

Y
if CheckInMethod=I

+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
if CheckInMethod or CheckOutMethod=M

See Manual Reasons Codes table below

 

56 

EarlyReason

Reason the visit was early

Alphanumeric

N

N
if check in occurred greater than 7 minutes before the scheduled start time

See Early Reasons Codes table below

 

57

EarlyAction

Action taken due to visit being early

Alphanumeric

N

N
if check in occurred greater than 7 minutes before the scheduled start time

See Early Actions Codes table below

 

58 

LateReason 

Reason the visit was late

Alphanumeric

N

N
if check in occurred between 7 and 29 minutes after the scheduled start time

See Late Reasons Codes table below

 

59 

LateAction 

Action taken due to visit being late

Alphanumeric

N

N
if check in occurred between 7 and 29 minutes after the scheduled start time

See Late Actions Codes table below

 

60

MissedReason 

Reason the visit was missed

Alphanumeric

N

N
if check in occurred greater than 30 minutes after the scheduled start time

See Missed Reasons Codes table below

 

61

MissedAction 

Action taken due to the visit being missed

Alphanumeric

N

N
if check in occurred greater than 30 minutes after the scheduled start time

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

 

Have more questions? Submit a request

Comments

1 comment
  • 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

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