Pre-Billing Validations

 

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CareBridge EVV Integration - Pre-Billing Validations

The following is a full list of pre-billing checks performed in the CareBridge Platform that would prevent a claim from being generated in the CareBridge Platform and would be returned as an error to the vendor that submitted the visit to CareBridge.  The table below includes a comprehensive list of CareBridge Pre-Billing alert validation responses - some may not be applicable to your specific integration.  

Click on Entity Type to be taken to that section:

Appointment (VCR#) | Authorization (A#) | Caregiver (CG#) | Claim (C#) | Member (M#) | Provider (P#) 

Error Code Entity Type Description

VCR1001

appointment

Caregiver First Name is invalid.

VCR1002

appointment

Caregiver Last Name is invalid.

VCR1003

appointment

Caregiver License Number is invalid.

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

Manual Reason is not valid.

VCR1051

appointment

Late Reason is not valid.

VCR1052

appointment

Late Action is not valid.

VCR1053

appointment

Missed Reason is not valid.

VCR1054

appointment

Missed Action is not valid.

VCR1055

appointment

Claim Action is not valid.

VCR1056

appointment

MCO Id is not valid.

VCR1057 appointment ICN is missing or invalid.

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

VCR1098

appointment

Caregiver Atypical ID is missing or invalid..

VCR1099

appointment

Diagnosis Code must be valid ICD10 code.

VCR1100

appointment

NPI does not exist on appointment.

VCR1101 appointment EVV Checkin Zip Code is not a valid zip code.
VCR1102 appointment EVV Checkout Zip Code is not a valid zip code.
VCR1103 appointment Manual Checkin Zip Code is not a valid zip code.
VCR1104 appointment Manual Checkout Zip Code is not a valid zip code.
VCR1105 appointment Location Start Zip Code is not a valid zip code.
VCR1106 appointment Location End Zip Code is not a valid zip code.
VCR1107 appointment Employee SSN is missing or invalid.
VCR1108 appointment Waiver Type is missing or invalid.
VCR1109 appointment Modifier 1 is not valid.
VCR1110 appointment Modifier 2 is not valid.
VCR1111 appointment Modifier 3 is not valid.
VCR1112 appointment Modifier 4 is not valid.
VCR1113 appointment Attending Provider First Name is missing.
VCR1114 appointment Attending Provider Last Name is missing.
VCR1115 appointment Attending Provider NPI is missing or invalid.
VCR1116 appointment Submitted Condition Code is invalid.
VCR1117 appointment Admission Date is missing or invalid.
VCR1118 appointment Patient Status is missing or invalid.
VCR1119 appointment Facility Type is not a valid type.
VCR1120 appointment Claim frequency is not a valid frequency code.
VCR1121 appointment Claim type is not a valid type.
VCR1122 appointment Referring Provider NPI is missing or invalid.
VCR1123 appointment Attending Provider Taxonomy Code is missing or invalid.

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.

VCR2004

appointment

Billed units exceeds max units for authorization per period.

VCR2005

appointment

Billed units exceeds daily max for HCPC.

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 exceeds actual units based on visit check in and check out times.

VCR2010

appointment

Visit check in and check out are outside of authorization's effective dates.

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

Provider NPI does not meet requirements for a valid 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.

VCR2063

appointment

Survey question external codes must be valid.

VCR2064

appointment

Care task external codes must be valid.

VCR2065

appointment

For procedure code 99509, members 21 and older must have HB modifier. Those under 21 must have a HA modifier.

VCR2066

appointment

The most recent claim request has failed. View claim history for more information.

VCR2067

appointment

Payer does not support sending voided claims.

VCR2068

appointment

Member is not present in the payer's membership file.

VCR2069 appointment Appointment cannot be billed outside of the active claim window.
VCR2070 appointment Appointment overlaps with other scheduled appointments and does not appear to be a valid group visit.
VCR2071 appointment Payer does not support voiding externally.
VCR2072 appointment Missing employee on appointment.
VCR2073 appointment Visit contains invalid survey responses..
VCR2074 appointment Tax id on appointment does not match the tax id on the provider.
VCR2075 appointment Procedure code is not a valid code for this payer.
VCR2076 appointment Appointment can not cross midnight.
VCR2077 appointment Provider State Registration is missing.
VCR2078 appointment Provider is not active according to the state roster.
VCR2079 appointment Visit does not meet the duration requirements for the service code.
VCR2080 appointment Overnight appointments are not allowed.
VCR2081 appointment Revenue code is missing or is not a valid code for this payer.
VCR2082 appointment Visit location type is required for home health services.
VCR2083 appointment Provider billing settings are required.
VCR2084 appointment CareBridge is no longer accepting visits for this payer.
VCR2085 appointment Vendor does not support selected billing frequency.
VCR2086 appointment Payment is not guaranteed.
VCR2087 appointment Authorizations in a pending status cannot be billed.
VCR2088 appointment Visit does not contain a valid ICD-10 diagnosis code.
VCR2089 appointment This member has a PCSP that has not yet been acknowledged.
VCR2090 appointment Visit does not contain a valid primary diagnosis code.
VCR2091 appointment One or more billing settings need to be configured prior to billing this visit.
VCR2092 appointment Paid appointments cannot be cancelled.
VCR2093 appointment Claim type is required when billing on more than 1 claim type is enabled.
VCR2094 appointment Value code is not valid.
VCR2095 appointment Member DOB on visit does not match member's DOB.
VCR2096 appointment Start date can not be before admission date.
VCR2097 appointment If Value Code or Value Code Amount exists, both must be populated.
C1001 claim Taxonomy Code is required.
C1002 claim Payer Claim Number is required for adjusted claims.
C1003 claim Provider Medicaid ID is required.
C1004 claim Total Charges is required.
C1005 claim Provider address is missing or incomplete.

C2001

claim

Claim could not be rolled up due to in flight claims.

C2002

claim

Appointment has 0 units to bill.

C2003

claim

Claim is not balanced.

C2004 claim Claim contains invalid durations for one or more billed services.
C2005 claim Claim line has partial units.
C2006 claim Primary diagnosis code is not a billable ICD-10 code.
C2007 claim Claim service dates don't cover line service dates.
C2008 claim Claim contains appointments with conflicting values for billing.
C2009 claim Claim line item control number is not unique.

CG1001

caregiver

Employee First Name is missing or invalid.

CG1002

caregiver

Employee Last Name is missing or invalid.

CG1003

caregiver

Employee License Number is missing or invalid.

CG1004

caregiver

Employee ID is missing or invalid.

CG1005

caregiver

Employee Hire Date is missing or invalid.

CG1006

caregiver

Employee Type is missing or invalid.

CG1007

caregiver

Employee Gender is missing or invalid.

CG1008

caregiver

Employee Date of Birth is missing or invalid.

CG1009

caregiver

Employee Medicaid ID is missing or invalid.

CG1010

caregiver

Employee Atypical ID is missing or invalid.
CG1011 caregiver Employee Zip is missing or invalid.

CG1012

caregiver

Employee SSN is missing or invalid.

CG1013 caregiver Caregiver Username is missing or invalid.

G1000

NULL

Generic Error

M1000

member

Generic Error

M1001

member

Medicaid ID is missing or invalid.

M1002

member

First Name is missing or invalid.

M1003

member

Middle Name is missing or invalid.

M1004

member

Last Name is missing or invalid.

M1005

member

Address Line 1 is missing or invalid.

M1006

member City is missing or invalid.

M1007

member

State is missing or invalid.

M1008

member

Zip is missing or invalid.

M1009

member

Date of Birth is missing or invalid.

M1012

member

Eligibility Start Date is missing or invalid.

M1013

member

Eligibility End Date is missing or invalid.

M1014

member

Eligibility end is in the past.

M1015

member

Invalid member Medicaid ID.

M2001

member

Member not associated to an authorization.

M2002

member

Date of Birth is in the future.

P1000

provider

Generic Error

P1001

provider

Tax ID is missing or invalid.

P1002

provider

Unique Identifier is missing.

P1003

provider Name is missing or invalid.

P1004

provider

Address Line 1 is missing or invalid.

P1005

provider

City is missing or invalid.

P1006

provider

State is missing or invalid.

P1007

provider

Zip is missing or invalid.

P1010

provider

Submitter ID is missing or invalid.

P1011

provider

Taxonomy Code is missing or invalid.

P1012

provider

Must have either NPI or alt_NPI.

P1013

provider

NPI is missing or invalid.

P1014

provider

Provider end date is in the past.

P1015

provider

Invalid NPI.

P1017

provider

Medicaid ID is missing or invalid.

P1018

provider

Provider has a PO Box address.

P1019

provider

Zip is missing or invalid.

P1021 provider Atypical ID

P2001

provider

Individual CDAC providers must have a Medicaid ID.

A1000

authorization

Generic Error

A1001

authorization

Authorization Reference Number is missing or invalid.

A1002

authorization

Service Code is missing or invalid.

A1003

authorization

Diagnosis Code is missing or invalid.

A1004

authorization

Provider Unique Identifier is missing.

A1005

authorization

Member Medicaid Id is missing.

A1006

authorization

Effective Date is missing or invalid.

A1007

authorization

Expiration Date is missing or invalid.

A1008

authorization

Max Units is missing or invalid.

A1009

authorization

Auth Limit Type is missing or invalid.

A1010

authorization

Modifier 1 is missing or invalid.

A1011

authorization

Modifier 2 is missing or invalid.

A1012

authorization

Modifier 3 is missing or invalid.

A1013

authorization

Modifier 4 is missing or invalid.

A1014

authorization

Authorization end date is in the past.

A1015

authorization

Attending Provider Name

A2001

authorization

Authorization could not be matched to a provider.

A2002

authorization

Authorization could not be matched to a member.

A2005

authorization

Member is not eligible during the authorized time frame.

A2006

authorization

Provider is not active during the authorized time frame.

A2007

authorization

Cannot change members.

A2011

authorization

No rate found for the procedure code.

A2012

authorization

No unit definitions found for the procedure code.

A2014

authorization

Authorization has multiple lines with different HCPC and modifier combinations in the same file.

A2015

authorization

Authorization is not for CDAC services but is associated to an individual CDAC provider.

A2016

authorization

Service Code is not valid.

A2017

authorization

Invalid NPI.

A2018

authorization

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

A2019

authorization

Rate exceeds max allowable rate.

A2020

authorization

Diagnosis Code must be valid ICD10 code.

A2021

authorization

Rate is missing.

A2022

authorization

Invalid service type for member over 21.
A2023

authorization

Service code is not in the list of authorized services.
A2025

authorization

Attending Provider NPI does not meet requirements for a valid NPI.
A2024

authorization

Attending Provider must have either NPI or AltID.
A2026

authorization

Provider Secondary ID required for procedure code.
A2027

authorization

An authorization for a corresponding service does not exist.
A2028

authorization

Authorization limit type is not allowed.
A2029 authorization Rate conflicts with one or more authorizations.
A2030 authorization Authorization Reference Number is missing Line Identifier.
A2031 authorization Max Units Per Partition calculation not evenly divisible.
A2032 authorization Authorization contains an invalid taxonomy code for the service code.
A2033 authorization Diagnosis code cannot be billed as a primary diagnosis code.