Appointment Status Report Specification

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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

NY

New York

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

Claim2_Status

Status of the claim in CareBridge

Alphanumeric

See Claim Status table below

59

Claim2_InvoiceNumber

Vendor’s invoice number as received in the visits file in either field 102 or invoice number generated by CareBridge

Alphanumeric

1001452

60

Claim2_PayerClaimNumber

Payer’s ICN number

Alphanumeric

2906973589

61

Claim2_StatusDate

Timestamp of when the status was updated in CareBridge

Datetime

YYYY-MM-DD HH:MM

“2020-01-01 14:00”

62

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”

63

Claim2_PayerStatusCode

Most recent status of the claim as received from the payer or third party aggregator

Alphanumeric

A1:20

64

Claim2_PayerStatusDescription

Description of the status code received from the payer or third party aggregator

Alphanumeric

Accepted for processing.

65

ProviderAtypicalId

As received in the visits file

Alphanumeric

 

66

CaregiverSSN

As received in the visits file

Alphanumeric

 

67

Line1_InvoiceNumber

Vendor’s invoice line number as received in the visits file in field 103 or invoice line number generated by CareBridge

Alphanumeric

 

68

Line2_InvoiceNumber

Vendor’s invoice line number as received in the visits file in field 104 or invoice line number generated by CareBridge

Alphanumeric

 

69

Aggregation1_RecipientName

Name of organization being sent aggregated data

Alphanumeric

HHAeXchange

70

Aggregation1_ExternalIdentifier

Identifier associated with the aggregated data for this ApptID

Alphanumeric

See Aggregation External Identifiers table below

71

Aggregation1_Status

 

Alphanumeric

See Aggregation Status table below

72

Aggregation1_ StatusDateTime

 

Datetime

YYYY-MM-DD HH:MM

“2021-01-01 14:00”

73

Aggregation2_RecipientName

 

Alphanumeric

Horizon

74

Aggregation2_ExternalIdentifier

Identifier associated with the aggregated data for this ApptID

Alphanumeric

See Aggregation External Identifiers table below

75

Aggregation2_Status

 

Alphanumeric

See Aggregation Status table below

76

Aggregation2_StatusDateTime

 

Datetime

YYYY-MM-DD HH:MM

“2021-11-01 14:00”

77

EvvVisitKey1

Key Used for Encounters Matching Purposes

 

Alphanumeric

0900-2401 NC5121867

78

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

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