Arkansas 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.

MCO/Payer ID Codes

Code

MCO/Payer

23921

Arkansas Total Care

28220

Empower Health Solutions

Code

Description

10

Contingency Plan Put in Place

11

Rescheduled Service for Same Day

12

Rescheduled Service for Different Day

13

Service Authorization Renewed and Services Resumed

14

Services Resumed at Next Scheduled Visit

15

Other (must include description in Comments section)

Code

Description

1

Provider Cancellation

2

Provider No-show

3

Enrollee Cancellation

4

Enrollee No-show

5

Scheduling Error due to Enrollee

6

Scheduling Error due to Provider

7

Service Authorization Issue

8

Other (must include description in Comments section)

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

Service Code

Description

HHAeXchange Service Type

 Unit of Service

Payer

T1019

Personal Care Services (Non-Skilled)

PCA

  

All Payers

T1019:U3

Personal Care Services (Non-Skilled)

PCA

  

All Payers

T1019:U4

Personal Care Services (Non-Skilled)

PCA

  

All Payers

T1019:U5

Personal Care Services (Non-Skilled)

PCA

  

All Payers
T1021 Home Health Aide Visit HHA 1 Unit = 1 Visit Empower Healthcare Solutions, Arkansas Total Care
T1021:TD Home Health RN Visit, Per Visit RN 4 Unit = 1 hour Empower Healthcare Solutions, Arkansas Total Care
T1021:TE Home Health LPN Visit, Per Visit LPN 4 Unit = 1 hour Empower Healthcare Solutions, Arkansas Total Care

S5125:U2

Attendant Care Services

PCS

  

Empower

S5150

Attendant Care Services

PCS

  

Empower
S9131 Home Health Physical Therapy by a Qualified Licensed Physical Therapist PT 4 Unit = 1 hour Empower Healthcare Solutions, Arkansas Total Care
S9131:UB Home Health Physical Therapy by a Qualified Physical Therapy Assistant PT 4 Unit = 1 hour Empower Healthcare Solutions, Arkansas Total Care

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.

Record needs imported as a…

Then, the following fields must be provided:

Billed Visit

  • Agency Tax ID

  • Caregiver Code

  • Caregiver First Name

  • Caregiver Last Name

  • Caregiver License Number

  • Caregiver SSN

  • Clock-In Service Location Address

  • Clock-Out Service Location Address

  • Invoice Number

  • Medicaid Number

  • Schedule ID

  • Payer ID

  • Procedure Code

  • Schedule End Time

  • 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.

Confirmed Visit

  • Agency Tax ID

  • Caregiver Code

  • Caregiver License Number

  • Caregiver First Name

  • Caregiver Last Name

  • Caregiver SSN

  • Clock-In Service Location Address

  • Clock-Out Service Location Address

  • 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 License Number

  • 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

  • Caregiver License Number

  • Medicaid Number

  • Missed Visit (Value should be "Y")

  • Missed Visit Reason Code

  • Missed Visit Action Taken Code

  • Payer ID

  • Procedure Code

  • Schedule ID

Rebilled Visit

  • Agency Tax ID

  • Caregiver Code

  • Caregiver License Number

  • Caregiver First Name

  • Caregiver Last Name

  • Caregiver SSN

  • Clock-In Service Location Address

  • Clock-Out Service Location Address

  • Invoice Number

  • Medicaid Number

  • Payer ID

  • Procedure Code

  • Schedule End Time

  • Schedule Start Time

  • TRN Number

  • Schedule ID

  • Submission Type

  • 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.

Schedule

  • Agency Tax ID

  • Caregiver Code

  • Caregiver License Number

  • Medicaid Number

  • Payer ID  

  • Procedure Code

  • Schedule End Time

  • Schedule ID

  • Schedule Start Time   

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

Code

Description

50

Change in schedule

51

Changed verification collection method and documented

52

Confirmed visit with the client or the client’s family member/representative and documented

53

Service(s) cancelled or suspended until further notice

54

Supervisor approved change

55

Timesheet received and signed by supervisor

56

Unspecified Action

57

Unverified visit; this service cannot be billed

58

Updated client’s address and documented

59

Updated client’s phone number and documented

60

Visit rescheduled

61

Other

Code

Description

400

Address did not link to the client (GPS)

401

Attendant failed to call in

402

Attendant failed to call in and out

403

Attendant failed to call out

404

Attendant failed to report to client's home

405

Attendant unable to connect to internet or EVV system down

406

Attendant unable to use mobile device

407

Attendant's identification number (s) does not match the scheduled shift

408

Client requested to change/cancel scheduled visit Scheduled visit has been cancelled due to the client's services being suspended

409

Client won't let attendant use phone

410

Client's phone line not working (technical issue or natural disaster)

411

Confirm Visits with no Schedule (Warning: May result in audit)

412

Disaster or Emergency

413

Fill-in for Regular Attendant or Assigned Staff

414

Fixed location device on order or pending placement in the home

415

Individual/Member Does Not Have Home Phone

416

Missing Small Alternative Device (Warning: May result in audit)

417

Multiple Calls For One Visit

418

Phone in use by client or individual in client's home

419

Reversal of Call In/Out Times (Warning: May result in audit)

420

Services Provided Outside the Home – Supported By Service Plan

421

Small Alternative Device Pending Installation (Warning: May result in audit)

422

Wrong Phone Number – Verified Services Were Delivered

423

Other (Warning: May result in audit)