Pre-Billing Validation Report

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Pre-Billing Validation Report File Specification

 

OVERVIEW

  • CareBridge can send a daily file which will report on appointments and visits that are not currently passing data validations and have pre-billing validation errors associated with them. Any appointment or visit that has a pre-billing error associated with it will not be able to be billed or correctly transmitted to Payers and/or State Aggregators. While these pre-billing errors are also reflected in the response files associated with each visits file that CareBridge receives, this report can be helpful in seeing the pre-billing errors across all visits files sent to date.
  • When an appointment or visit no longer has any pre-billing errors associated with it, the appointment will no longer be reported on.
  • The Pre-Billing Validations Report file will not contain the entirety of data that was sent on a visits file, but rather a subset of key attributes needed to identify a visit as well as the accompanying error.
  • The Pre-Billing Validations Report file can be accessed from the Third-Party EVV vendors established CareBridge SFTP mailbox in the output folder.
  • The Pre-Billing Validations Report will be generated by State and TaxID, with all outstanding appointment errors for the provider included in the file.
  • Vendors interested in receiving 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 Pre-Billing Validation / Error

NAMING CONVENTION

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

 

Data File Format

Field No Field Name Description Data Type Example

VendorName 

Name of EVV vendor sending data

Alphanumeric

EVV Vendor

2

FileName

Name of the visits file that the appointment / visit was most recently sent on

Alphanumeric

VISITS_{State}_ProviderTaxID_YYYYMMDDHHMMSS.CSV

TransactionId 

As received in the visits file 

Alphanumeric 

9243 

ApptID 

As received in the visits file

Alphanumeric

1231248391

CareBridgeApptID 

CareBridge’s ID for the appointment

Numeric

1231248391

MemberMedicaidID 

As received in the visits file

Alphanumeric

362714245

ProviderTaxID 

As received in the visits file

Alphanumeric

208076837

8

MCOID 

As received in the visits file

Alphanumeric

IA_AGP

9

ErrorCode

The error code indicating the type of issue

Alphanumeric

VCR2001

10

ErrorDescription

The description of the error code, this is dynamic based on the error

Alphanumeric

Member is not eligible for visit duration

11

ErrorSeverity

Indicates the severity of the error.  This will always return ERROR

Alphanumeric

ERROR

12

AggVendor

This field identifies the Aggregation Vendor that generated the error (see AggVendors table below)

Alphanumeric

HHAeXchange

 

AggVendors

For visits sent to CareBridge that are then transmitted to another entity for aggregation purposes, CareBridge will pass back any errors received on these visits from the outbound aggregation vendor.  Vendors will need to contact the outbound aggregation vendor for additional details regarding specific error codes.  Listed below are the Vendor Names as they will appear in the AggVendor column. Errors with an AggVendor value populated and not Pre-Billing Errors.

State Vendor Name Payers

AR

AuthentiCare

Fee for Service

AR

HHAeXchange - Agg

Arkansas Total Care, Empower

NJ

HHAeXchange

All Payers

NJ

Horizon Agg

Horizon

Pre-Billing Validations

The following is a full list of pre-billing validations performed in the CareBridge Platform that would prevent a claim from being generated in the CareBridge Platform and would be returned as an error in the response file to the vendor that submitted the visit to CareBridge.  

 

Error Number 

entity_type 

description 

M1000 

member 

Generic Error 

M1001 

member 

Medicaid Id 

M1002 

member 

First name is missing or invalid 

M1003 

member 

Middle Name 

M1004 

member 

Last name 

M1005 

member 

Address 1 

M1006 

member 

City 

M1007 

member 

State 

M1008 

member 

Zip 

M1009 

member 

Date of birth 

M1012 

member 

Eligibility start date 

M1013 

member 

Eligibility end date 

M2001 

member 

Member not associated to an auth 

P1000 

provider 

Generic Error 

P1001 

provider 

Tax id 

P1002 

provider 

Unique identifier 

P1003 

provider 

Name 

P1004 

provider 

Address 1 

P1005 

provider 

City 

P1006 

provider 

State 

P1007 

provider 

Zip 

P1010 

provider 

Submitter Id 

P1012 

provider 

Must have either npi or alt_npi 

A1000 

authorization 

Generic Error 

A1001 

authorization 

Auth ref no 

A1002 

authorization 

Hcpc 

A1003 

authorization 

Diagnosis code 

A1004 

authorization 

Provider unique id 

A1005 

authorization 

Member unique id 

A1006 

authorization 

Start date 

A1007 

authorization 

End date 

A1008 

authorization 

Units 

A1009 

authorization 

Partition type 

A1010 

authorization 

Modifier 1 

A1011 

authorization 

Modifier 2 

A1012 

authorization 

Modifier 3 

A1013 

authorization 

Modifier 4 

A2001 

authorization 

Provider match 

A2002 

authorization 

Member match 

A2005 

authorization 

Member in-eligible 

A2006 

authorization 

Provider in-eligible 

A2007 

authorization 

Cannot change members 

A2011 

authorization 

No rate found for the procedure code 

A2012 

authorization 

No unit definitions found for the procedure code 

A2017 

authorization 

Invalid npi 

VCR1001 

appointment 

Caregiver First Name 

VCR1002 

appointment 

Caregiver Last Name 

VCR1003 

appointment 

Caregiver License Number 

VCR1004 

appointment 

Vendor name is not valid 

VCR1005 

appointment 

Transaction Id is not valid 

VCR1006 

appointment 

Transaction Date Time is not valid 

VCR1007 

appointment 

Provider Id is not valid 

VCR1008 

appointment 

Provider Name is not valid 

VCR1009 

appointment 

Provider Tax Id is not valid 

VCR1010 

appointment 

Provider NPI is not valid 

VCR1011 

appointment 

Member First Name is not valid 

VCR1012 

appointment 

Member Last Name is not valid 

VCR1013 

appointment 

Member Medicaid Id is not valid 

VCR1014 

appointment 

Appointment Start DateTime is not valid 

VCR1015 

appointment 

Appointment End DateTime is not valid 

VCR1016 

appointment 

EVV CheckIn DateTime is not valid 

VCR1017 

appointment 

EVV CheckIn Method is not valid 

VCR1018 

appointment 

EVV CheckIn Street Address is not valid 

VCR1019 

appointment 

EVV CheckIn City is not valid 

VCR1020 

appointment 

EVV CheckIn State is not valid 

VCR1021 

appointment 

EVV CheckIn Zip is not valid 

VCR1022 

appointment 

EVV CheckIn Latitude Longitude is not valid 

VCR1023 

appointment 

EVV CheckOut DateTime is not valid 

VCR1024 

appointment 

EVV CheckOut Method is not valid 

VCR1025 

appointment 

EVV CheckOut Street Address is not valid 

VCR1026 

appointment 

EVV CheckOut City is not valid 

VCR1027 

appointment 

EVV CheckOut State is not valid 

VCR1028 

appointment 

EVV CheckOut Zip is not valid 

VCR1029 

appointment 

EVV CheckOut Latitude Longitude is not valid 

VCR1030 

appointment 

Manual CheckIn DateTime is not valid 

VCR1031 

appointment 

Manual CheckIn Method is not valid 

VCR1032 

appointment 

Manual CheckIn Street Address is not valid 

VCR1033 

appointment 

Manual CheckIn City is not valid 

VCR1034 

appointment 

Manual CheckIn State is not valid 

VCR1035 

appointment 

Manual CheckIn Zip is not valid 

VCR1036 

appointment 

Manual CheckOut DateTime is not valid 

VCR1037 

appointment 

Manual CheckOut Method is not valid 

VCR1038 

appointment 

Manual CheckOut Street Address is not valid 

VCR1039 

appointment 

Manual CheckOut City is not valid 

VCR1040 

appointment 

Manual CheckOut State is not valid 

VCR1041 

appointment 

Manual CheckOut Zip is not valid 

VCR1042 

appointment 

Auth Reference Number is not valid 

VCR1043 

appointment 

Service Code is not valid 

VCR1044 

appointment 

Time Zone is not valid 

VCR1045 

appointment 

CheckIn IVR Phone Number is not valid 

VCR1046 

appointment 

CheckOut IVR Phone Number is not valid 

VCR1047 

appointment 

Diagnosis Code is not valid 

VCR1048 

appointment 

Attestation is not valid 

VCR1049 

appointment 

Rate is not valid 

VCR1050 

appointment 

Invalid Manual Reason is not valid 

VCR1051 

appointment 

Invalid Late Reason is not valid 

VCR1052 

appointment 

Invalid Late Action is not valid 

VCR1053 

appointment 

Invalid Missed Reason is not valid 

VCR1054 

appointment 

Invalid Missed Action is not valid 

VCR1055 

appointment 

Invalid Claim Action is not valid 

VCR1056 

appointment 

MCO Id is not valid 

VCR1058 

appointment 

Employee Id is not valid 

VCR1059 

appointment 

Early visit reason is not valid 

VCR1060 

appointment 

Early visit action is not valid 

VCR1061 

appointment 

EVV CheckIn distance 

VCR1062 

appointment 

EVV CheckOut distance 

VCR1063 

appointment 

EVV CheckIn reason is not valid 

VCR1064 

appointment 

EVV CheckOut reason is not valid 

VCR1065 

appointment 

Survey questions and responses are required 

VCR1066 

appointment 

Appointment does not contain the same number of survey questions and answers 

VCR1067 

appointment 

Caregiver tasks are required 

VCR1068 

appointment 

Caregiver hire date is not valid 

VCR1069 

appointment 

Caregiver type is not valid 

VCR1070 

appointment 

Caregiver gender is not valid 

VCR1071 

appointment 

Caregiver date of birth is not valid 

VCR1072 

appointment 

Claim 1 invoice number is not valid 

VCR1073 

appointment 

Claim 2 invoice number is not valid 

VCR1074 

appointment 

Line 1 invoice number is not valid 

VCR1075 

appointment 

Line 2 invoice number is not valid 

VCR1076 

appointment 

Caregiver Medicaid Id is not valid 

VCR1077 

appointment 

Appointment Id is not valid 

VCR1078 

appointment 

Provider Medicaid Id is not valid 

VCR1079 

appointment 

Member date of birth is invalid 

VCR1080 

appointment 

Payer claim number 1 is not valid 

VCR1081 

appointment 

Billing status 1 is not valid 

VCR1082 

appointment 

Billed amount 1 is not valid 

VCR1083 

appointment 

Billed units 1 is not valid 

VCR1084 

appointment 

Paid amount 1 is not valid 

VCR1085 

appointment 

Paid units 1 is not valid 

VCR1086 

appointment 

Payer claim number 2 is not valid 

VCR1087 

appointment 

Billing status 2 is not valid 

VCR1088 

appointment 

Billed amount 2 is not valid 

VCR1089 

appointment 

Billed units 2 is not valid 

VCR1090 

appointment 

Paid amount 2 is not valid 

VCR1091 

appointment 

Paid units 2 is not valid 

VCR1092 

appointment 

Invalid claim action 

VCR1093

appointment 

Invalid member medicaid id

VCR1094

appointment 

Completed visit requires member attestation

VCR1095

appointment 

Appointment start after end

VCR1096

appointment 

Appointment EVV checkin after checkout

VCR1097

appointment 

Appointment manual checkin after checkout

VCR2001 

appointment 

Member is not eligible for visit duration 

VCR2002 

appointment 

Provider is not active during visit duration based on provider active_start & active_end date 

VCR2003 

appointment 

"Billed units exceeds max units for Authorization. Used(#{used}) & Available(#{available}) Max(#{max})" 

VCR2004 

appointment 

"Billed units exceeds max units for Authorization per period(#{part}). Used(#{used}) & Available(#{available}) Total(#{max})" 

VCR2005 

appointment 

"Billed units for HCPC-Mod (#{hcpc}-#{mod1}-#{mod2}) exceeds daily max. Used(#{used_units}) Allowed(#{max_units})" 

VCR2006 

appointment 

Late visit missing late visit reason 

VCR2007 

appointment 

Missed visit missing missed visit reason 

VCR2008 

appointment 

Manual confirmation visit missing Manual confirmation reason 

VCR2009 

appointment 

"Billed units (#{billed}) exceed actual units(#{actual}) based on visit CheckIn and CheckOut" 

VCR2010 

appointment 

"Visit CheckIn(#{appt_start_at}) and CheckOut(#{appt_end_at}) are outside of authorized period(#{auth_start}, #{auth_end})" 

VCR2011 

appointment 

Member does not match authorization 

VCR2012 

appointment 

Visit is not associated to an authorization 

VCR2013 

appointment 

Member is not associated to the visit 

VCR2014 

appointment 

Reject if authorization has block claiming flag set 

VCR2015 

appointment 

Reject if provider has block claiming flag set 

VCR2016 

appointment 

Reject if member has block claiming flag set 

VCR2017 

appointment 

No rate found for the procedure code 

VCR2018 

appointment 

No unit definitions found for the procedure code 

VCR2019 

appointment 

Invalid action given the state of in flight claims 

VCR2020 

appointment 

Visit cannot span more than two days 

VCR2021 

appointment 

Authorization has been termed 

VCR2022 

appointment 

Provider does not match authorization 

VCR2023 

appointment 

Provider is not associated to the visit 

VCR2024 

appointment 

Appointment must contain CheckIn and CheckOut data in order to be claimed 

VCR2025 

appointment 

Appointment overlaps with another appointment 

VCR2026 

appointment 

Early visit is missing early visit reason 

VCR2027 

appointment 

Late visit is missing late visit action 

VCR2028 

appointment 

Missed visit is missing missed visit action 

VCR2029 

appointment 

Early visit is missing early visit action 

VCR2030 

appointment 

EVV CheckIn is outside of the allowed radius require a reason code 

VCR2031 

appointment 

EVV CheckOut is outside of the allowed radius require a reason code 

VCR2032 

appointment 

Vendor is not approved to send claim ICNs 

VCR2033 

appointment 

Vendor is not approved to send line level ICNs 

VCR2034 

appointment 

Cannot submit both claim level and line level ICNs 

VCR2035 

appointment 

Appointment crosses midnight but only 1 ICN was provided 

VCR2036 

appointment 

Appointment does not cross midnight but multiple ICNs were provided 

VCR2037 

appointment 

Appointment is attempting to rollup with other appointments that contain different ICNs 

VCR2038 

appointment 

Vendor is configured to send ICNs but did not send any 

VCR2039 

appointment 

Claim was not submitted within the timely filing window 

VCR2040 

appointment 

Past appointment can no longer be manually modified 

VCR2041 

appointment 

Must have a provider npi or provider medicaid id 

VCR2042 

appointment 

Payer does not support claim generation 

VCR2043 

appointment 

ICNs cannot be re-used for multiple claims 

VCR2044 

appointment 

Caregiver is not active 

VCR2045 

appointment 

Invalid npi 

VCR2046 

appointment 

Visit cannot exceed 24 hours 

VCR2047 

appointment 

Visit duration cannot be zero 

VCR2048 

appointment 

EVV CheckIn cannot be in the future 

VCR2049 

appointment 

EVV CheckOut cannot be in the future 

VCR2050 

appointment 

Manual CheckIn cannot be in the future 

VCR2051 

appointment 

Manual CheckOut cannot be in the future 

VCR2052 

appointment 

Cannot claim a visit in the future 

VCR2053 

appointment 

Visit has an EVV CheckOut without a CheckIn 

VCR2054 

appointment 

Visit has a manual CheckOut without a CheckIn 

VCR2055 

appointment 

Visit requires a modifier or includes a modifier that is not allowed 

VCR2056 

appointment 

Cannot claim a cancelled appointment 

VCR2057 

appointment 

CheckIn phone number only allowed for IVR CheckIns 

VCR2058 

appointment 

CheckOut phone number only allowed for IVR CheckOuts 

VCR2059

appointment

Missing provider medicaid id

VCR2060

appointment

Provider must have either NPI or API

VCR2061

appointment

Members 21 and older must have U3 modifier. Those under 21 must not

VCR2062

appointment

Rate exceeds max allowable rate

C2001 

claim 

Claim could not be rolled up due to in flight claims 

C2002 

claim 

Appointment has 0 units to bill 

G1000 

NULL 

Generic Error 

This is a comprehensive list of CareBridge Pre-Billing validation responses – some may not be applicable to your specific integration.  

 

Error Severity

The following list defines the possible types of error severity.

 

Severity 

Description 

ERROR

This is the standard error severity for pre-billing validations

WARNING

This can be used for less severe data issues (not currently in use)

 

 

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