New York Centers Plan EDI Codes

The EDI Codes topic defines specific codes used in the import interface process.

Refer to Homecare EDI Import for import details and interface instructions.

If additional assistance is needed, submit a ticket to 3rd Party Integration Support Desk. Cases are escalated to the EDI Production Support queue.

The Payer ID is the unique identifier for each MCO, sent as a required field in the EDI Import file. The following table provides the MCO/Payer ID Code for each Payer.

Code MCO/Payer
17129 Centers Plan

The following tables provide the codes and descriptions for the Missed Visit Action Taken fields for the Additional Visits Info EDI Import Interface file.

If a Missed Visit is canceled (unchecked), the codes revert to the Visit Edit Code Tables (Reason and Action Taken).

Code Description
50 Confirmed with the client or the client’s family member/representative and documented
51 Confirmed with the client or the client’s family member/representative and documented (this service cannot be billed)
52 New attendant assigned to client
53 Service(s) cancelled or suspended until further notice
54 Unverified visit; this service cannot be billed
55 Visit rescheduled
56 Other

The following tables provide the codes and descriptions for the Missed Visit Reason Code fields for the Additional Visits Info EDI Import Interface file.

If a Missed Visit is canceled (unchecked), the codes revert to the Visit Edit Code Tables (Reason and Action Taken).

Code Description
500 Agency unable to provide replacement coverage (no show, no replacement)
501 Attendant failed to report to client’s home
502 Client requested to change/cancel scheduled visit; or the scheduled visit has been cancelled due to the client's services being suspended.
510 COVID-19: Participant refused, receiving service through informal supports
511 COVID-19: Participant refused, self-isolating, not receiving service
512 COVID-19: Participant is in hospital or Nursing Facility
513 COVID-19: Worker unable to staff because they are sick
514 COVID-19: Worker unable to staff because of childcare issues
515 COVID-19: Worker switched to cover another case
516 COVID-19: Other (Provide details in the Note section)
517 Other

The following table provides Procedure Codes (Service Codes) and descriptions.

Code Description
T1019:U1 PCS LEVEL II BASIC – 15 MINUTES
T1019:U6 CDPA BASIC – 15 MINUTES
T1020 PCS LEVEL II LIVE-IN
T1020:U2 PCS LEVEL II LIVE-IN TWO CLIENT
T1020:U6 CDPA LIVE IN
T1020:U7 CDPA LIVE IN TWO CONSUMERS

There are required fields per file document which must be in specific format. The following table provides the applicable required fields per EDI Import File Type. This EDI Import Interface supports the following import operations into HHAeXchange.

If record needs to be imported as a… Then, the following fields must be provided:

Confirmed Visit

  • Agency Tax ID

  • Caregiver Code

  • Caregiver First Name

  • Caregiver Last Name

  • Caregiver SSN

  • Clock-In Service Location Type

  • Clock-Out Service Location Type

  • Medicaid Number

  • Payer ID

  • Procedure Code

  • Schedule End Time

  • Schedule ID

  • Schedule Start Time

  • Visit End Time

  • Visit Start Time

*The EVV fields are required if visit was confirmed via EVV or IVR. Visit Edit and Action Taken codes are required if visit was manually edited.

Delete a Schedule

  • Agency Tax ID

  • Caregiver Code

  • Caregiver First Name

  • Caregiver Last Name

  • Caregiver SSN

  • Is Deletion (Value should be “Y”)

  • Medicaid Number

  • Payer ID

  • Procedure Code

  • Schedule End Time

  • Schedule ID

  • Schedule Start Time

Missed Visit

  • Agency Tax ID

  • Caregiver Code

  • Medicaid Number

  • Missed Visit (Value should be "Y")

  • Missed Visit Action Taken Code

  • Missed Visit Reason Code

  • Payer ID

  • Procedure Code

  • Schedule ID

The following tables provide the codes and descriptions for the Visit Edit Action Taken fields for the following EDI Import Interface files: Confirmed Visits and Billed Visits.

Code Description
10 Confirmed visit with the client or the client's family member/representative and documented
11 Supervisor approved change
12 Updated client's phone number and documented
13 Changed verification collection method and documented
14 Timesheet received and signed by supervisor
15 Confirmed visit with outside entity and documented
16 Visit rescheduled
17 Updated client's address and documented
18 New attendant assigned to client
19 Unverified visit; this service cannot be billed
20 Service(s) cancelled or suspended until further notice
21 Timesheet Verified
22 Mutual Case/ or Cluster Case/ or Live-in Case
23 Change in schedule
24 Confirmed with the client or the client's family member/representative and documented (this service cannot be billed)
25 Confirmed with the client or the client's family member/representative and documented
26 Other

The following tables provide the codes and descriptions for the Visit Edit Reason fields for the following EDI Import Interface files: Confirmed Visits and Billed Visits.

Code Description
100 Phone number did not link to the client.
101 Client will not let attendant use phone.
102 Client does not have a phone in home.
103 Phone in use by client or individual in client's home.
104 Client received services outside of the home.
105 Client's phone line not working (technical issue or natural disaster).
106 Client requested to change/cancel scheduled visit; or the scheduled visit has been cancelled due to the client's services being suspended.
107 Address did not link to the client (GPS).
108 Attendant failed to call in.
109 Attendant failed to call out.
110 Attendant failed to call in and out.
111 Attendant called in to or out of the EVV system early or late.
112 Attendant's identification number(s) does not match the scheduled shift.
113 Attendant entered invalid fixed location device code(s).
114 Attendant failed to report to client's home.
115 Fixed location device on order or pending placement in the home.
116 Fixed location device malfunctioned.
117 Attendant unable to use mobile device.
118 Attendant unable to connect to internet or EVV system down.
119 Data Entry Error
120 Agency unable to provide replacement coverage (no show, no replacement).
121 Timesheet Received
122 Other