Tennessee

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(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. 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.
    • 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

Field Value Description
ERROR_CODE See sections below The error code indicating the type of issue
ERROR_DESCRIPTION See sections below The description of the error code, this is dynamic based on the error
IS_FILE_ERROR True or False Indicates if the error is a file level error or row / field level error
ERROR_SEVERITY ERROR or WARNING Indicates the severity of the error
FILE_NAME Name of the inbound file Name of the file that was received by CareBridge

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

Error Number Description
F1001 File is not an expected file type.
F1002 File contains invalid delimiters.
F1003 File cannot be parsed, it may be incomplete or invalid.
F1004 File is a duplicate.
F1005 File exceeds max allowed file size. (5 GB)

 

Appointments / Visits Data File Format

Field No  Field Name  Description Data Type Required for Scheduled Appointment Required for
Completed Visit
Example Max Length

VendorName 

Name of EVV vendor sending data

Alphanumeric

Y

Y

EVV Vendor

 

TransactionID 

Unique identifier for the transaction and should be unique in every file. It is only used for tracking and troubleshooting purposes

Alphanumeric 

Y

Y

71256731

 

TransactionDateTime 

Time stamp associated with the visit data being sent to CareBridge in UTC

Datetime

Y

Y

YYYY-MM-DDTHH:MM:SSZ

“2020-01-01T14:00:00Z”

 

ProviderID 

Unique identifier for the provider

Alphanumeric

Y

Y

43134

100

ProviderName 

Name of provider 

Alphanumeric

Y

Y

Home Health, LLC

255

ProviderNPI 

NPI of provider
 

Numeric

Y
(required unless the provider is atypical)

Y
(required unless the provider is atypical)

1609927608

10

ProviderEIN 

Tax ID or EIN of provider 

Alphanumeric

Y

Y

208076837

 

9

ProviderMedicaidID

MedicaidID number for Provider

Alphanumeric

N

N

982123567

 

ApptID 

Unique identifier for the visit, used to identify an appointment and should be consistent for every appointment update

Alphanumeric 

Y

Y

1231248391

100

10 

CaregiverFName 

First name of caregiver who completed the visit  

Alphanumeric

Y

Y

John

 

11 

CaregiverLName 

Last name of caregiver who completed the visit  

Alphanumeric

Y

Y

Smith

 

12

CaregiverID 

Unique ID Assigned to caregiver (Employee ID) 

Alphanumeric

Y

Y

982123

 

13

MemberFName 

First name of member

Alphanumeric 

Y

Y

Jane

 

14

MemberLName 

Last name of member

Alphanumeric 

Y

Y

Johnson

 

15

MemberDateOfBirth

Date of birth of member

Alphanumeric

N

N

YYYY-MM-DD

 

16 

MemberMedicaidID1 

Medicaid ID for member 2 letters followed by 9 digits

Alphanumeric

Y

Y

TD123456789

11

17 

MemberID1 

Member Insured / Subscriber ID  

Alphanumeric

N

N

47138493

 

18

ApptStartDateTime

Date / Time that the appointment was scheduled to begin

DateTime

Y

Y

YYYY-MM-DDTHH:MM:SSZ

“2020-01-01T14:00:00Z”

 

19

ApptEndDateTime

Date / Time that the appointment was scheduled to end

DateTime

Y

Y

YYYY-MM-DDTHH:MM:SSZ

“2020-01-01T14:00:00Z”

 

20

ApptCancelled

(C) if appointment was cancelled

Alphanumeric

N

N

C

 

21 

CheckInDateTime 

Date / Time that the visit was checked into

Datetime 

N

Y

YYYY-MM-DDTHH:MM:SSZ

“2020-01-01T14:00:00Z”

 

22

CheckInMethod

EVV (E), Manual (M), IVR (I)

Alphanumeric

N

Y

E

 

23 

CheckInStreetAddress 

Street address where check in occurred

Alphanumeric

N

Y

926 Main St

 

24

CheckInStreetAddress2 

Additional street address info where check in occurred

Alphanumeric

N

N

Suite B

 

25 

CheckInCity 

City where check in occurred 

Alphanumeric

N

Y

Nashville

 

26 

CheckInState 

State where check in occurred  

Alphanumeric

N

Y

TN

 

27 

CheckInZip 

Zip code where check in occurred

Alphanumeric

N

Y

37206

 

28 

CheckInLat 

Latitude of coordinates where check in occurred

Alphanumeric

N

Y
if CheckInMethod=E

##.######

 

29 

CheckInLong 

Longitude of coordinates where check in occurred 

Alphanumeric

N

Y
if CheckInMethod=E

###.######

 

30 

CheckOutDateTime 

Date / Time that the visit was checked out of

Datetime 

N

Y

YYYY-MM-DDTHH:MM:SSZ

“2020-01-01T14:00:00Z”

 

31

CheckOutMethod

EVV (E), Manual (M), IVR (I)

Alphanumeric

N

Y

E

 

32 

CheckOutStreetAddress 

Address where check out occurred

Alphanumeric

 

N

Y

926 Main St

 

33 

CheckOutStreetAddress2 

Additional address info where check out occurred

Alphanumeric

N

N

Suite B

 

34

CheckOutCity 

City where check out occurred

Alphanumeric

N

Y

Nashville

 

35 

CheckOutState 

State where check out occurred

Alphanumeric

N

Y

TN

 

36 

CheckOutZip 

Zip code where check out occurred 

Alphanumeric

N

Y

37206

 

37 

CheckOutLat 

Latitude of coordinates where check out occurred

Alphanumeric

N

Y
if CheckOutMethod=E

##.######

 

38 

CheckOutLong 

Longitude of coordinates where check out occurred 

Alphanumeric

 

N


if CheckOutMethod=E

###.######

 

39 

AuthRefNumber 

Authorization Number as indicated by health plan

Alphanumeric

Y

Y (with exceptions outlined in the Prior Authorization Requirements Section)

1080421390

 

40 

ServiceCode 

Service code for services rendered during visit (HCPCS Procedure Code)

Alphanumeric 

Y

Y

S5125

 

41 

Modifier 1 

Modifier code for services rendered during visit

Alphanumeric

N

N

U5

 

42 

Modifier 2 

Second modifier code for services rendered during visit  

Alphanumeric

N

N

UA

 

43 

Modifier 3 

Third modifier code for services rendered during visit  

Alphanumeric

N

N

96

 

44 

Modifier 4 

Fourth modifier code for services rendered during visit  

Alphanumeric

N

N

59

 

45

RevenueCode

Revenue Code that should be used for billing 

Alphanumeric

N

Y

See Service and Revenue Code and Unit Definitions below

 

46

TimeZone 

Time zone that the visit took place in  

Alphanumeric 

Y

Y

US/Eastern

 

47 

CheckInIVRPhoneNumber 

Phone Number used to check in 

Alphanumeric 

N

Y
if CheckInMethod=I

+14156665555

 

48 

CheckOutIVRPhoneNumber 

Phone Number used to check out 

Alphanumeric 

N

Y
if CheckInMethod=I

+14156665555

 

49 

ApptNote 

Free text note related to the visit

Alphanumeric 

N

N

Scheduling related note

 

50 

DiagnosisCode 

Tilda delimited list of ICD-10 Diagnosis code attributed to the visit. (Enter in the order that they are billed and primary dx should be the first listed.)

Alphanumeric 

N

Y

I50.9~R68.89

 

 

51 

ApptAttestation 

Member attestation associated with the visit

Alphanumeric 

N

N

See Member Attestation Codes table below

 

52

Rate 

Billed unit rate associated with the visit 

Decimal 

Y

Y
(required if
ClaimAction= N or C)

3.85

 

53 

ManualReason 

Reason for manual entry associated with the visit

Alphanumeric 

N

Y
if CheckInMethod or
CheckOutMethod=M

See Manual Reasons Codes table below

 

54 

LateReason2 

Reason the visit was late

Alphanumeric 

N

N2

See Late Reasons Codes table below

 

55

LateAction2 

Action taken due to visit being late

Alphanumeric 

N

N2

See Late Actions Codes table below

 

56

MissedReason3 

Reason the visit was missed

Alphanumeric 

N

N3

See Missed Reasons Codes table below

 

57

MissedAction3 

Action taken due to the visit being missed

Alphanumeric 

N

N3

See Missed Actions Codes table below

 

58

CaregiverSurveyQuestions

Tilda delimited list of survey questions presented to the caregiver

Alphanumeric

N

N

Has the member fallen since the last visit?~Is the member looking or acting different than they usually do?

 

59

CaregiverSurveyResponses

Tilda delimited list of survey responses to questions presented to the caregiver in the same order as the questions listed in CaregiverSurveyQuestions field

Alphanumeric

N

N

Yes~No

 

60

ClaimAction 

New Claim (N), Void (V), Claims Billed Externally-Not Via CareBridge (E) 

Alphanumeric 

N

Y

N

 

61

MCOID 

Identifies health plan the member is associated with 

Alphanumeric 

Y

Y

See MCOID table below

 

101

Claim Invoice Number 1

Claim level invoice number in third-party system

These fields can be used for reconciliation of the data sent to CareBridge. 

If you would like to use these fields, please contact the CareBridge Integration team at evvintegration@carebridgehealth.com

To enable these fields, additional testing is required.

102

Claim Invoice Number 2

Claim level invoice number in third-party system

103

Line Item Invoice Number 1

Unique identifier of the invoice line item in the third-party

104

Line Item Invoice Number 2

Unique identifier of the invoice line item in the third-party system

1 MemberID can be used as a member identifier instead of MemberMedicaidID.  If MemberID is used, MemberMedicaidID is not a required field.

2 A visit is considered late if check in occurred between one and three hours after a scheduled start time.  An informational alert/warning will trigger in this event; CareBridge will not require that providers enter Late Reason/Actions in order to bill.

3 A visit is considered missed if check in is greater than three hours after a scheduled start time.  An informational alert/warning will trigger in this event; CareBridge will not require that providers enter Missed Reason/Actions in order to bill.

 

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

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

S9123   0552 TN_AGP, 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   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

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 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

 

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

Code Description
MA1000 Complete
MA1005 Member Refused
MA1010 Member Unable
MA1015 No Signature (Other)


Manual Reasons Codes

Code Description

MR1000

Caregiver error

MR1005

No access to application or IVR

MR1010

Technical error

MR1015

Duplicates/overlapping

MR1020

Forgot to clock in/out

MR1025

Missing/waiting for authorization

MR1030

Employee removed from current budget

MR1035

Possible EIN issues

MR1040

Overtime with two service codes and no OT Agreement

MR1045

Over budget without a form on file

MR1050

Member Initiated

MR1055

New Agency Using EVV


Late Reasons Codes

Code Description
LR1000 Caregiver forgot to check in
LR1005 Technical issue
LR1010 Member would not allow staff to use device
LR1015 Member rescheduled
LR1020 Scheduling Error


Late Reason Actions Taken Codes

Code Description
LA1000 Rescheduled
LA1005 Back-up plan initiated
LA1010 Contacted service coordinator
LA1015 Contacted MCO member services
LA1020 Caregiver checked in late


Missed Reasons Codes

Code Description

MVR1000

Caregiver did not show up

MVR1005

Caregiver forgot to check in / out

MVR1010

Technical issue

MVR1015

Unplanned hospitalization

MVR1020

Authorization not in place at time of visit

MVR1025

Member or family refused service

MVR1030

Provider agency unable to staff

MVR1035

Member rescheduled

MVR1040

Scheduling Error


Missed Visit Actions Taken Codes

Code Description

MVA1000

Rescheduled

MVA1005

Back-up plan initiated

MVA1010

Contacted service coordinator

MVA1015

Contacted MCO member services

MVA1020

Service provided as scheduled

 

MCOID Codes* 

Code Description

TN_AGP

Wellpoint Tennessee

TN_UHC

UnitedHealthcare Community Plan of Tennessee

 

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

 

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