Appointment Status Report Specification

OVERVIEW

CareBridge can send a daily file which will report on the status of all appointments received for a provider agency. This report will contain information regarding the status of claims for the appointment, the billed amount, and whether there are unresolved pre-billing errors for the appointment.
Each ApptID CareBridge has received that does not have all related claims resolved for an agency and vendor will be included as a single row on this report.
When claims for an appointment reach a Paid, Denied, or Billed Externally status in the CareBridge system, the appointment will be included in the report one final time, then removed the following day.
If an appointment status is updated to Cancelled, the appointment will be included in the report one final time, then removed the following day.
The Appointment Status Report file can be accessed from the Third-Party EVV vendors established CareBridge SFTP mailbox in the output folder.
The Appointment Status Report will be generated by state and tax ID, with all outstanding appointments included in the file.
Fields 58 – 64 are in place to accommodate split claims.
Appointments that are unable to be imported will not be included in this report.
Vendors interested in this report should email evvintegration@carebridgehealth.com to opt-in.
- For Vendors in North Carolina, this report will be enabled by default.
A PDF of this document is available here

FILE FORMAT SPECIFICATIONS

File type: CSV (pipe-delimited)
One row per appointment / visit
All DateTime fields are in UTC with zero offset

NAMING CONVENTION

The general naming convention is as follows:
APPOINTMENT_STATUS_{state_prefix}_{tax_id}_{file_id}_YYYYMMDDHHMMSS.CSV
Ex. APPOINTMENT_STATUS_IA_12345678946_100001624_2021020107000.CSV

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

TEST_APPOINTMENT_STATUS_{state_prefix}_{tax_id}_{file_id}_YYYYMMDDHHMMSS.CSV
Ex. TEST_APPOINTMENT_STATUS_IA_12345678946_100001624_2021020107000.CSV

State Abbreviations
AR	Arkansas
IA	Iowa
NC	North Carolina
NJ	New Jersey
TN	Tennessee
WY	Wyoming

DATA FIELD SPECIFICATIONS

Appointment Status Report Data Format

Field No	Field Name	Description	Data Type	Example
1	VendorName	Name of EVV vendor sending data	Alphanumeric	EVV Vendor
2	TransactionId	As received in the visits file	Alphanumeric	9243
3	TransactionDateTime	Time stamp as received in the visits file.	Datetime	YYYY-MM-DD HH:MM “2020-01-01 14:00”
4	ApptID	As received in the visits file	Alphanumeric	1231248391
5	CareBridgeApptID	CareBridge’s ID for the appointment	Numeric	1000
6	ProviderID	As received in the visits file	Alphanumeric	43134
7	ProviderName	As received in the visits file	Alphanumeric	Home Health, LLC
8	ProviderNPI	As received in the visits file	Numeric	1609927680
9	ProviderEIN	As received in the visits file	Alphanumeric	208076837
10	ProviderMedicaidID	As received in the visits file	Alphanumeric	982123567
11	CaregiverFName	First name of the caregiver for the CaregiverID in the visits file.	Alphanumeric	Jason
12	CaregiverLName	Last name of the caregiver for the CaregiverID in the visits file.	Alphanumeric	Connell
13	CaregiverID	CaregiverID in the visits file	Alphanumeric	7
14	CaregiverLicenseNumber	License Number of the caregiver for the CaregiverID in the visits file (AR and NJ only)	Alphanumeric	34TT08675309
15	CaregiverDateOfBirth	Date of Birth of the caregiver for the CaregiverID in the visits file. (NJ only)	Alphanumeric	YYYY-MM-DD “1947-03-31”
16	CaregiverHireDate	Hire Date of the caregiver for the CaregiverID in the visits file. (NJ only)	Alphanumeric	YYYY-MM-DD “2019-04-05”
17	CaregiverType	Caregiver type for the CaregiverID in the visits file. (NJ only)	Alphanumeric	non_skilled
18	CaregiverGender	Last name of the caregiver for the CaregiverID in the visits file. (NJ only)	Alphanumeric	M
19	MemberFName	As received in the visits file	Alphanumeric	Jane
20	MemberLName	As received in the visits file	Alphanumeric	Johnson
21	MemberMedicaidID	As received in the visits file	Alphanumeric	236362714245
22	MemberID	As received in the visits file	Alphanumeric	47138493
23	ApptStartDateTime	As received in the visits file	DateTime	YYYY-MM-DD HH:MM “2020-01-01 14:00”
24	ApptEndDateTime	As received in the visits file	DateTime	YYYY-MM-DD HH:MM “2020-01-01 14:00”
25	CheckInMethod	E, I, or M as received in the visits file	Alphanumeric	E
26	CheckInDateTime	As received in the visits file	DateTime	YYYY-MM-DD HH:MM “2020-01-01 14:00”
27	CheckInStreetAddress	As received in the visits file	Alphanumeric	926 Main St
28	CheckInStreetAddress2	As received in the visits file	Alphanumeric	Suite B
29	CheckInCity	As received in the visits file	Alphanumeric	Nashville
30	CheckInState	As received in the visits file	Alphanumeric	TN
31	CheckInZip	As received in the visits file	Alphanumeric	37206
32	CheckInLat	As received in the visits file, if CheckInMethod = E	Alphanumeric	##.#########
33	CheckInLong	As received in the visits file, if CheckInMethod = E	Alphanumeric	##.#########
34	CheckOutMethod	E, I, or M as received in the visits file	Alphanumeric	E
35	CheckOutDateTime	As received in the visits file	DateTime	YYYY-MM-DD HH:MM “2020-01-01 14:00”
36	CheckOutStreetAddress	As received in the visits file	Alphanumeric	926 Main St
37	CheckOutStreetAddress2	As received in the visits file	Alphanumeric	Suite B
38	CheckOutCity	As received in the visits file	Alphanumeric	Nashville
39	CheckOutState	As received in the visits file	Alphanumeric	TN
40	CheckOutZip	As received in the visits file	Alphanumeric	37206
41	CheckOutLat	As received in the visits file, if CheckInMethod = E	Alphanumeric	##.#########
42	CheckOutLong	As received in the visits file, if CheckInMethod = E	Alphanumeric	##.#########
43	AuthRefNumber	As received in the visits file	Alphanumeric	1080421390
44	ServiceCode	As received in the visits file	Alphanumeric	S5125
45	TimeZone	As received in the visits file	Alphanumeric	US/Eastern
46	MCOID	As received in the visits file	Alphanumeric	IA_AGP
47	AppointmentStatus	Status for this ApptID in CareBridge	Alphanumeric	See Appointment Status table below
48	HasErrors	True or False depending on whether there are unresolved pre-billing validation errors for this ApptID	Boolean	TRUE
49	BilledUnits	Number of units billed to the payer	Decimal	8
50	BilledAmount	Amount billed to the payer	Decimal	100
51	Claim1_Status	Status of the claim in CareBridge	Alphanumeric	See Claim Status table below
52	Claim1_InvoiceNumber	Vendor’s invoice number as received in the visits file in field 101 or invoice number generated by CareBridge	Alphanumeric	1001452
53	Claim1_PayerClaimNumber	Payer’s ICN number	Alphanumeric	2906973589
54	Claim1_StatusDate	Timestamp of when the status was updated in CareBridge	Datetime	YYYY-MM-DD HH:MM “2020-01-01 14:00”
55	Claim1_DateLastChecked	Timestamp of when CareBridge last checked on the status of the claim	Datetime	YYYY-MM-DD HH:MM “2020-01-01 14:00”
56	Claim1_PayerStatusCode	Most recent status of the claim as received from the payer or third-party aggregator	Alphanumeric	A1:2
57	Claim1_PayerStatusDescription	Description of the status code received from the payer or third-party aggregator	Alphanumeric	Accepted for processing.
58	Claim1_FrequencyCode	Frequency Code for the first claim	Alphanumeric	1
59	Claim2_Status	Status of the claim in CareBridge	Alphanumeric	See Claim Status table below
60	Claim2_InvoiceNumber	Vendor’s invoice number as received in the visits file in either field 102 or invoice number generated by CareBridge	Alphanumeric	1001452
61	Claim2_PayerClaimNumber	Payer’s ICN number	Alphanumeric	2906973589
62	Claim2_StatusDate	Timestamp of when the status was updated in CareBridge	Datetime	YYYY-MM-DD HH:MM “2020-01-01 14:00”
63	Claim2_DateLastChecked	Timestamp of when CareBridge last checked on the status of the claim	Datetime	YYYY-MM-DD HH:MM “2020-01-01 14:00”
64	Claim2_PayerStatusCode	Most recent status of the claim as received from the payer or third party aggregator	Alphanumeric	A1:20
65	Claim2_PayerStatusDescription	Description of the status code received from the payer or third party aggregator	Alphanumeric	Accepted for processing.
66	Claim2_FrequencyCode	Frequency Code for the second claim	Alphanumeric	7
67	ProviderAtypicalId	As received in the visits file	Alphanumeric
68	CaregiverSSN	As received in the visits file	Alphanumeric
69	Line1_InvoiceNumber	Vendor’s invoice line number as received in the visits file in field 103 or invoice line number generated by CareBridge	Alphanumeric
70	Line2_InvoiceNumber	Vendor’s invoice line number as received in the visits file in field 104 or invoice line number generated by CareBridge	Alphanumeric
71	Aggregation1_RecipientName	Name of organization being sent aggregated data	Alphanumeric	HHAeXchange
72	Aggregation1_ExternalIdentifier	Identifier associated with the aggregated data for this ApptID	Alphanumeric	See Aggregation External Identifiers table below
73	Aggregation1_Status		Alphanumeric	See Aggregation Status table below
74	Aggregation1_ StatusDateTime		Datetime	YYYY-MM-DD HH:MM “2021-01-01 14:00”
75	Aggregation2_RecipientName		Alphanumeric	Horizon
76	Aggregation2_ExternalIdentifier	Identifier associated with the aggregated data for this ApptID	Alphanumeric	See Aggregation External Identifiers table below
77	Aggregation2_Status		Alphanumeric	See Aggregation Status table below
78	Aggregation2_StatusDateTime		Datetime	YYYY-MM-DD HH:MM “2021-11-01 14:00”
79	EvvVisitKey1	Key Used for Encounters Matching Purposes	Alphanumeric	0900-2401 NC5121867
80	EvvVisitKey2	Key Used for Encounters Matching Purposes	Alphanumeric	0900-2401 NC5121867

Data Field Information

The “visit file” referenced in the field description table refers to the file(s) received by CareBridge from a third-party vendor containing the specific visit information.
Fields in this file will correspond to the stored values for the corresponding ApptID.
- If all field values in the visits file received by CareBridge were valid, the values in this file will match the values we received.
- If fields in visits file received by CareBridge were invalid and could not be stored, the appointment status file will contain null values in those fields.
If an appointment has been updated multiple times, the appointment status file will contain the most recent field values.
Caregiver related fields are connected to a CaregiverID for a particular Vendor, Provider, and MCO. Each time a CaregiverID is received as part of a visit, it will update the other Caregiver related fields, and the current information for that CaregiverID will be included in the Appointment Status file.
Check-in and check-out fields (DateTime, Lat, Long, Street Address, Street Address 2, City, State, and Zip) will not be included on the Appointment Status file if the corresponding CheckInMethod or CheckOutMethod is null or an invalid value.
Appointments where the "HasErrors" column is false, but the Claim1_Status or Claim2_Status columns have values of "prebilling_rejection" simply need to be re-submitted without changes to successfully generate claims.
The EvvVisitKey1 and EvvVisitKey2 values are intended to be used to support Encounters data in North Carolina, which must be submitted directly by Third-Party Vendors to Sandata.

Appointment Status Codes

Code	Description
scheduled	ApptStartDateTime for visit is in the future
in_progress	CheckInMethod is E or I and CheckInDateTime is not null, and CheckOutDateTime is null
late	Current time is after ApptStartDateTime by interval defined in state specific tech specs and CheckInDateTime is null
late_in_progress	CheckInDateTime occurs after ApptStartDateTime by interval defined in state specific tech specs and CheckOutDateTime is null
missed	Current time is after ApptStartDateTime by interval defined in state specific tech specs and CheckInDateTime is null
missed_in_progress	CheckInMethod is E or I and CheckInDateTime occurs after ApptStartDateTime by interval defined in state-specific tech specs and CheckOutDateTime is null
early_in_progress	CheckInMethod is E or I and CheckInDateTime occurs before ApptStartDateTime by interval defined in state specific tech specs (AR only) and CheckOutDateTime is null
cancelled	ApptCancelled field has value C
completed	Visit has CheckInDateTime and CheckOutDateTime values and CheckInDateTime is within allowable window of ApptStartDateTime (i.e. not late or missed)
late_completed	Visit has CheckInDateTime and CheckOutDateTime values and CheckInDateTime occurs after ApptStartDateTime by interval defined in state specific tech specs
missed_completed	Visit has CheckInDateTime and CheckOutDateTime values and CheckInDateTime occurs after ApptStartDateTime by interval defined in state specific tech specs
early_completed	Visit has CheckInDateTime and CheckOutDateTime values and CheckInDateTime occurs before ApptStartDateTime by interval defined in state specific tech specs (AR only)
completed_manual	CheckInMethod or CheckOutMethod is M and visit has CheckInDateTime and CheckOutDateTime values and CheckInDateTime is within allowable window of ApptStartDateTime
completed_manual_late	CheckInMethod or CheckOutMethod is M and Visit has CheckInDateTime and CheckOutDateTime values and CheckInDateTime occurs after ApptStartDateTime by interval defined in state specific tech specs
completed_manual_missed	CheckInMethod or CheckOutMethod is M and Visit has CheckInDateTime and CheckOutDateTime values and CheckInDateTime occurs after ApptStartDateTime by interval defined in state specific tech specs
completed_manual_early	CheckInMethod or CheckOutMethod is M and Visit has CheckInDateTime and CheckOutDateTime values and CheckInDateTime occurs before ApptStartDateTime by interval defined in state specific tech specs (AR only)

Claim Status Codes

Code	Description
null	This visit did not attempt to create a claim. Visit was sent with ClaimAction null.
prebilling_rejection	This visit has not generated a claim due to unresolved pre-billing validation errors
queued	This visit has been queued for claim generation as part of the nightly export from CareBridge to Clearinghouse or MCO
generated	This visit has a claim that has been generated, but not yet submitted to the MCO.
submitted	This visit has a claim that has been submitted to the MCO.
acknowledged	This visit has a claim that has been received by the MCO.
confirmed	This visit has a claim that was accepted by the MCO.
rejected	This visit was rejected by the MCO due to insufficient or invalid data upon initial review of the claim.
paid	This visit was paid by the MCO.
denied	This visit was denied by the MCO due to insufficient or invalid data upon review of the claim.
voided	This visit claim was voided. Visit sent to CareBridge with ClaimAction “V”
failed	There was an internal CareBridge error processing this claim
billed_externally	This visit had a claim billed outside of CareBridge. Visit sent to CareBridge with ClaimAction “E”

Aggregation External Identifiers

Aggregation Recipient	Identifier Name	Description
HHAeXchange – New Jersey	TransactionID	TransactionID associated to the most recent attempt to aggregate the visit to HHA
Horizon – New Jersey	TransactionID	TransactionID associated to the most recent attempt to aggregate the visit to Horizon
Authenticare - Arkansas	TransactionID	TransactionID associated to the most recent attempt to aggregate visit to Authenticare

Aggregation Statuses

Code	Description
new	Aggregation attempt has been queued, but not yet been sent
sent	Aggregation attempt has been sent, but CareBridge has not received a response back from the Aggregation Recipient
completed	CareBridge has received a response from the Aggregation Recipient that the aggregation was successful
failed	CareBridge has received a response from the Aggregation Recipient that the aggregation has failed. Errors for failed Aggregation attempts are available on the Appointment Errors Report

Appointment Status Report Specification

OVERVIEW

FILE FORMAT SPECIFICATIONS

NAMING CONVENTION

DATA FIELD SPECIFICATIONS

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