(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.
   1. Provider takes action on response errors and resubmits
      1. It is the responsibility of the Third-Party EVV Vendor to ensure providers can correct errors within their EVV system and are able to resubmit the corrected visits to CareBridge.
      2. CareBridge provides daily reports on outstanding pre-billing errors via the supplemental Pre-Billing Validation Report.
4. CareBridge utilizes visits data to generate claims and submits to clearinghouse / MCOs.
5. CareBridge provides daily updates on visit status via the supplemental Appointment Status Report.
6. Providers can continue to receive claim remittances through previously established mechanisms.

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.

 

Appointments / Visits data should be submitted to CareBridge at least once daily for all appointments / visits that have had incremental changes since last submission.

 

Do not continue to re-send appointments / visits that have not changed unless instructed by CareBridge or the visit has prebilling errors.

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)

• Double quotes within the data itself should be escaped using double quotes (“””)
• Headers should be included
• One row per appointment / visit
• All DateTime fields should be UTC 
• Visit data will be placed in an on hold claim status if there is already an existing ApptID that is part of the same claim, 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_TN_ProviderTaxID_YYYYMMDDHHMMSS.CSV

For Test Files, “TEST” will prepend the file name as follows:
TEST_VISITS_TN_ProviderTaxID_YYYYMMDDHHMMSS.CSV
Note: The state initials are required for files to be processed.

CareBridge Response File

VISITS_TN_ProviderTaxID_ERROR_YYYYMMDDHHMMSS.txt

 

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

TEST_VISITS_TN_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 in TN and is sending production data, additional testing is not required for Home Health Phase 2.

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: Tennessee - 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 > Tennessee  - 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 successful 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, providers must set their billing frequency within our system prior to vendors sending production data on their behalf.  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.

 

Billing Frequency

Providers will have the ability to select their billing frequency. Options are:

• Daily
• Weekly
• Monthly

This can be communicated to CareBridge by reaching out to evvintegrationsupport@carebridgehealth.com

 

Once billing frequency has been set, vendors can begin sending production appointment/visit data to the production environment.

CareBridge highly recommends that EVV Vendors follow the process outlined below:

 

1. Send a file in the production environment with actual visit/appointment data.

   a. Only send 1-5 rows of data initially.
   b. Send visit data with the ClaimAction field as null.
   c. At least one row of data should 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, both 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. 1. 1. The Pre-Billing Validation Report in addition to response files to ensure providers have the most up-to-date information regarding outstanding visit errors.
           2. The 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 integration process.

DATA FIELD SPECIFICATIONS

CareBridge Response File Format

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

 

Appointments / Visits Data File Format

 

Home Health Service Codes and Unit Definitions (Phase 1)

Service Code	Modifiers	RevenueCode	Payer(s)	Procedure Name	Unit Type	Unit Quantity
T1000		0589	TN_AGP, TN_UHC	Private duty/independent nursing service(s) - licensed	Minutes	15
T1000	UN	0589	TN_UHC	Private duty/independent nursing service(s) - licensed	Minutes	15
S9122		0552	TN_AGP	Home health aide or certified nurse assistant, providing care in the home	Hours	1
S9122		0572	TN_AGP, TN_UHC	Home health aide or certified nurse assistant, providing care in the home	Hours	1
S9122	UN	0572	TN_UHC	Home health aide or certified nurse assistant, providing care in the home	Hours	1
S9123		0552	TN_AGP, TN_UHC	Nursing care, in the home; by registered nurse	Hours	1
S9123	UN	0552	TN_UHC	Nursing care, in the home; by registered nurse	Hours	1
S9123		0572	TN_AGP	Nursing care, in the home; by registered nurse	Hours	1
S9124		0552	TN_AGP, TN_UHC	Nursing care, in the home; by licensed practical nurse	Hours	1
S9124	UN	0552	TN_UHC	Nursing care, in the home; by licensed practical nurse	Hours	1
S9124		0589	TN_AGP	Nursing care, in the home; by licensed practical nurse	Hours	1

^{*  Phase 1 Services will always have prior authorizations and therefore, will always require AuthRefNumber to be populated}

Home Health Service and Revenue Codes and Unit Definitions (Phase 2) – TN Wellpoint

Service Code	Modifiers	RevenueCode	Procedure Name	Prior Authorized1	Unit Type*	Unit Quantity*
G0151	GP, CQ	0421	Intermittent Home Health Physical Therapy Visit	Sometimes	Visit	1
G0151	GP, CQ	0424	Intermittent Home Health Physical Therapy Visit	Sometimes	Visit	1
G0152	GO, CO	0431	Intermittent Home Health Occupational Therapy Visit	Sometimes	Visit	1
G0152	GO, CO	0434	Intermittent Home Health Occupational Therapy Visit	Sometimes	Visit	1
G0153	GN	0441	Intermittent Home Health Speech Therapy Visit	Sometimes	Visit	1
G0153	GN	0444	Intermittent Home Health Speech Therapy Visit	Sometimes	Visit	1
G0155	None	0561	Intermittent Home Health Social Worker Visit	Sometimes	Visit	1
G0156	None	0571	Intermittent Home Health Aide Visit	Sometimes	Visit	1
G0157	CQ	0421	Intermittent Home Health Physical Therapy Assistant Visit	Sometimes	Visit	1
G0158	CO	0431	Intermittent Home Health Occupational Therapy Assistant Visit	Sometimes	Visit	1
G0299	None	0551	Intermittent Home Health Skilled Nursing Visit RN	Sometimes	Minutes	15
G0300	None	0551	Intermittent Home Health Skilled Nursing Visit LPN	Sometimes	Minutes	15
G0300	None	0581	Intermittent Home Health Skilled Nursing Visit LPN	Sometimes	Minutes	15

^{1 See Prior Authorization Requirements section below}

^{* Providers can override unit definitions by Service Code and Payer in the CareBridge Provider portal.}

Home Health Service and Revenue Codes and Unit Definitions (Phase 2) – UnitedHealthcare Community Plan of Tennessee

Service Code	Allowed Modifiers1	RevenueCode	Procedure Name	Prior Authorized2	Unit Type*	Unit Quantity*
G0151	SE, XE, GP	0421	Intermittent Home Health Physical Therapy Visit	Sometimes	Visit	1
G0151	SE, XE, GP	0424	Intermittent Home Health Physical Therapy Visit	Sometimes	Visit	1
G0152	XE, GO, SE	0431	Intermittent Home Health Occupational Therapy Visit	Sometimes	Visit	1
G0152	XE, GO, SE	0434	Intermittent Home Health Occupational Therapy Visit	Sometimes	Visit	1
G0153	XE, GN, SE	0441	Intermittent Home Health Speech Therapy Visit	Sometimes	Visit	1
G0153	XE, GN, SE	0444	Intermittent Home Health Speech Therapy Visit	Sometimes	Visit	1
G0155	XE, SE, HA, SD	0560	Intermittent Home Health Social Worker Visit	Sometimes	Visit	1
G0155	XE, SE, HA, SD	0561	Intermittent Home Health Social Worker Visit	Sometimes	Visit	1
G0155	XE, SE, HA, SD	0569	Intermittent Home Health Social Worker Visit	Sometimes	Visit	1
G0156	XE, SE	0571	Intermittent Home Health Aide Visit	Sometimes	Visit	1
G0157	XE, GP, SE	0421	Intermittent Home Health Physical Therapy Assistant Visit	Sometimes	Visit	1
G0158	XE, GO, SE	0431	Intermittent Home Health Occupational Therapy Assistant Visit	Sometimes	Visit	1
G0159	XE, GP, SE	0421	Intermittent Home Health Physical Therapy Visit	Always	Visit	1
G0159	XE, GP, SE	0424	Intermittent Home Health Physical Therapy Visit	Always	Visit	1
G0160	XE, GO, SE	0431	Intermittent Home Health Occupational Therapy Visit	Always	Visit	1
G0160	XE, GO, SE	0434	Intermittent Home Health Occupational Therapy Visit	Always	Visit	1
G0162	XE, SE	0551	Intermittent Home Health RN Visit	Sometimes	Visit	1
G0299	XE, SE	0551	Intermittent Home Health Skilled Nursing Visit RN	Sometimes	Visit	1
G0300	XE, SE	0551	Intermittent Home Health Skilled Nursing Visit LPN	Sometimes	Visit	1
G0300	XE, SE	0581	Intermittent Home Health Skilled Nursing Visit LPN	Sometimes	Visit	1
G0493	XE, SE	0551	Intermittent Home Health RN Visit	Always	Visit	1
G0494	XE, SE	0551	Intermittent Home Health LPN Visit	Always	Visit	1
G0495	XE, SE	0551	Intermittent Home Health RN Visit	Always	Visit	1
G0496	XE, SE	0551	Intermittent Home Health LPN Visit	Always	Visit	1
S9127	XE, SE	0551 0561	Social work visit, in the home, per diem	Always	Visit	1
S9129	XE, GO, SE	0431	Occupational therapy, in the home, per diem.	Always	Visit	1
S9129	XE, GO, SE	0434	Occupational therapy, in the home, per diem.	Always	Visit	1
S9131	XE, GP, SE	0421	Physical therapy; in the home, per diem	Always	Visit	1
S9131	XE, GP, SE	0424	Physical therapy; in the home, per diem	Always	Visit	1
S9474	XE, SE	0551	Enterostomal therapy by a registered nurse certified in enterostomal therapy, per diem	Always	Visit	1

^{1 See Phase 2 Service Code Modifiers - UnitedHealthcare Community Plan of Tennessee Section below} 

^{2 See Prior Authorization Requirements section below}

^{* Providers can override unit definitions by Service Code and Payer in the CareBridge Provider portal.} 

 

Phase 2 Service Code Modifier Requirements – UnitedHealthcare Community Plan of Tennessee

For EVV Visit Data for UnitedHealthcare, the rules for modifiers are as follows:

• Modifiers will not be utilized as a matching criterion for authorizations.  Necessary billing modifiers should be added to visits by providers via the Modifier fields in the table above (Modifier 1, Modifier 2, Modifier 3, Modifier 4).
• CareBridge will not generate prebilling alerts based on the presence or absence of modifiers.  Any combination of modifiers listed in the table above for a specific procedure code may be included without restriction. However, incorrect modifier combinations per payer claiming requirements may result in denied claims.
• Where listed as an available modifier, GN, GO, and GP should be included for claims.  These should be included in one of the modifier fields in the table above.
• The XE modifier should be used when there are multiple visits for the member, DOS, service code, and provider that do not roll up together onto a single claim line. 
• Note: This information is specific to TN_UHC visits. TN_AGP visits should not include modifiers.

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

Manual Reasons Codes

Late Reasons Codes

Late Reason Actions Taken Codes

Missed Reasons Codes

Missed Visit Actions Taken Codes

 

MCOID Codes^* 

 

Pre-Billing Validations

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