North Carolina Standard Plans 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
24075 Carolina Complete Health
24147 AmeriHealth Caritas of North Carolina
28238 United Healthcare Community Plan of NC
23937 WellCare of North Carolina
57537 AmeriHealth Caritas of North Carolina HHCS
57535 Carolina Complete Health HHCS
57542 UnitedHealthcare Community Plan of NC HHCS
57538 WellCare of North Carolina LTSS HHCS

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
30 Confirmed with the member or the member's family member/representative and documented (this service cannot be billed)
31 New attendant assigned to member (this service cannot be billed)
32 Service(s) cancelled or suspended until further notice (this service cannot be billed)
33 Unverified visit; this service cannot be billed
34 Visit rescheduled (this service cannot be billed)
35 Other (this service cannot be billed)

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
700 Agency unable to provide replacement coverage (no show, no replacement)
701 Attendant failed to report to client's home
702 Member requested to change/cancel scheduled visit; or the scheduled visit has been cancelled due to the client's services being suspended
703 Member Refused Service
704 Member Refused Service - original aide on vacation
705 Hospitalization unplanned
706 COVID-19: All other cases where the agency could not staff due to COVID-19
707 COVID-19: Member refused, self-isolating, not receiving service
708 COVID-19: Member refused, receiving service through informal supports
709 Other (If selecting Other, please provide additional details in the Note section)

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

Service Code Description Payers
92507 TREATMENT OF SPEECH, LANGUAGE, VOICE, COMMUNICATION, AND/OR AUDITORY PROCESSING DISORDER; INDIVIDUAL WCNC
92521 EVALUATION OF SPEECH FLUENCY ACNC, UHC NC, WCNC
92522 EVALUATE SPEECH PRODUCTION ACNC, UHC NC, WCNC
92523 SPEECH SOUND LANG COMPREHEN ACNC, UHC NC, WCNC
97116 THERAPEUTIC PROCEDURE, 1 OR MORE AREAS, EACH 15 MINUTES; GAIT TRAINING (INCLUDES STAIR CLIMBING) WCNC
97161 PHYSICAL THERAPY EVALUATION LOW COMPLEX 20 MINS ACNC, UHC NC, WCNC
97162 PHYSICAL THERAPY EVALUATION MOD COMPLEX 30 MINS ACNC, UHC NC, WCNC
97163 PHYSICAL THERAPY EVALUATION HIGH COMPLEX 45 MINS ACNC, UHC NC, WCNC
97164 PHYSICAL THERAPY RE-EVAL EST PLAN CARE 20 MINS ACNC, UHC NC, WCNC
97165 OCCUPATIONAL THERAPY EVAL LOW COMPLEX 30 MINS ACNC, UHC NC, WCNC
97166 OCCUPATIONAL THERAPY EVAL MOD COMPLEX 45 MINS ACNC, UHC NC, WCNC
97167 OCCUPATIONAL THERAPY EVAL HIGH COMPLEX 60 MINS ACNC, UHC NC, WCNC
97168 OCCUPATIONAL THER RE-EVAL EST PLAN CARE 30 MINS ACNC, UHC NC, WCNC
97533 SENSORY INTEGRATIVE TECHNIQUES TO ENHANCE SENSORY PROCESSING AND PROMOTE ADAPTIVE RESPONSES TO ENVIRONMENTAL DEMANDS, DIRECT WCNC
99509:HA Personal Care Services, Private Residences Under 21 ACNC, CCH, UHC NC, WCNC
99509:HB Personal Care Services, Private Residences Over 21 ACNC, CCH, UHC NC, WCNC
G0151 Physical Therapy ACNC, CCH, WCNC
G0152 SRVC OT HOM HLTH/HOSPICE EA 15 MIN ACNC, CCH, WCNC
G0153 SRVC SPCHANDLANG PATH HH/HOSPIC EA 15 ACNC, CCH, WCNC
G0156 SRVC HH/HOSPICE AIDE EA 15 MIN ACNC, CCH, WCNC
G0157 PT assistant ACNC, CCH, WCNC
G0158 SRVC OT ASSIST HH/HOSPICE EA 15 MIN ACNC, CCH, WCNC
G0159 RC420 PT establish or deliver safe and effective PT maintenance program ACNC, WCNC
G0159 RC424 SRVC PT HH EST/DEL PT MP EA 15 MINS ACNC, WCNC
G0160 RC430 SRVC OT HH EST/DEL OT MP EA 15 MIN ACNC, WCNC
G0160 RC434 SRVC OT HH EST/DEL OT MP EA 15 MIN ACNC, WCNC
G0161 SRVC SLP HH EST/DEL SLP TX MP 15 MN ACNC, CCH, WCNC
G0162 SKILLED SRVC RN MANDE POC EA 15 MINS ACNC, CCH, WCNC
G0283 E-STIM 1/>NOT WND CARE PART TX PLAN ACNC, WCNC
G0299 RC551 DIR SNS RN HH/HOSPICE SET EA 15 MIN ACNC, CCH, WCNC
G0299 RC559 DIR SNS RN HH/HOSPICE SET EA 15 MIN ACNC, CCH, WCNC
G0299 RC580 DIR SNS RN HH/HOSPICE SET EA 15 MIN ACNC, CCH, WCNC
G0299 RC581 DIR SNS RN HH/HOSPICE SET EA 15 MIN ACNC, CCH, WCNC
G0300 RC551 DIR SNS LPN HH/HOSPCE SET EA 15 MIN ACNC, CCH, WCNC
G0300 RC559 DIR SNS LPN HH/HOSPCE SET EA 15 MIN ACNC, CCH, WCNC
G0300 RC580 DIR SNS LPN HH/HOSPCE SET EA 15 MIN ACNC, CCH, WCNC
G0300 RC581 DIR SNS LPN HH/HOSPCE SET EA 15 MIN ACNC, CCH, WCNC
G0493 RN CARE EA 15 MIN HH/HOSPICE ACNC, CCH, WCNC
G0494 LPN CARE EA 15MIN HH/HOSPICE ACNC, CCH, WCNC
G0495 RC551 RN CARE TRAIN/EDU IN HH/HOSPICE ACNC, CCH, WCNC
G0495 RC559 RN CARE TRAIN/EDU IN HH/HOSPICE ACNC, CCH, WCNC
G0496 RC551 RN CARE TRAIN/EDU IN HH/HOSPICE CCH
G0496 RC559 RN CARE TRAIN/EDU IN HH/HOSPICE CCH
G2168  Services performed by minutes ACNC, WCNC
G2169 SERVICES PRFRM BY OT ASST HH SETTING EA 15 MIN ACNC, CCH, WCNC
S9122 HOM HLTH AIDE/CNA PROV CARE HOM HR ACNC, WCNC
S9123 RC551 NRS CARE HOM REGISTERED NURSE-HOUR ACNC, WCNC
S9123 RC559 NRS CARE HOM REGISTERED NURSE-HOUR ACNC, WCNC
S9128  SPEECH THERAPY IN THE HOME PER DIEM ACNC, UHC NC, WCNC
S9129 OCCUPATIONAL THERAPY HOME PER DIEM ACNC, UHC NC, WCNC
S9131 PHYSICAL THERAPY HOME PER DIEM ACNC, UHC NC, WCNC
T1001 Skilled nursing: Initial assessment/re- assessment UHC NC
T1002 RC551 RN SERVICES UP TO 15 MINUTES ACNC, WCNC
T1002 RC559 RN SERVICES UP TO 15 MINUTES ACNC, WCNC
T1021 Home health aide or certified nurse assistant, per visit ACNC, UHC NC, WCNC
T1030 RC551 Skilled nursing: Treatment, teaching/training, observation/evaluation UHC NC
T1030 RC580 Skilled nursing: venipuncture UHC NC
T1030 RC581 Skilled nursing: Pre- filling insulin syringes/Medi- Planners UHC NC
T1031 RC551 Skilled nursing: Treatment, teaching/training, observation/evaluation UHC NC
T1031 RC580 Skilled nursing: venipuncture UHC NC
T1031 RC581 Skilled nursing: Pre- filling insulin syringes/Medi- Planners UHC NC

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 Address

  • Clock-Out Service Location Address

  • Clock-In Service Location Type

  • Clock-Out Service Location Type

  • Diagnosis Code

  • Medicaid Number

  • Payer ID

  • Procedure Code

  • Schedule End Time

  • Schedule ID

  • Schedule Start Time

  • User Field 1 (Clock-In Call Type)

  • User Field 2 (Clock-Out Call 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.

Billed Visit

  • Agency Tax ID

  • Caregiver Code

  • Caregiver First Name

  • Caregiver Last Name

  • Caregiver SSN

  • Clock-In Service Location Address

  • Clock-Out Service Location Address

  • Clock-In Service Location Type

  • Clock-Out Service Location Type

  • Diagnosis Code

  • Invoice Number

  • Medicaid Number

  • Payer ID

  • Procedure Code

  • Schedule End Time

  • Schedule ID

  • Schedule Start Time

  • User Field 1 (Clock-In Call Type)

  • User Field 2 (Clock-Out Call 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.

*Visits need to be invoiced 1 invoice per member/DOS/procedure code.
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

Rebilled Visit 

  • Agency Tax ID

  • Caregiver Code

  • Caregiver First Name

  • Caregiver Last Name

  • Caregiver SSN

  • Clock-In Service Location Address

  • Clock-Out Service Location Address

  • Clock-In Service Location Type

  • Clock-Out Service Location Type

  • Diagnosis Code

  • Invoice Number

  • Medicaid Number

  • Payer ID

  • Procedure Code

  • Schedule End Time

  • Schedule ID

  • Schedule Start Time

  • Submission Type

  • TRN Number

  • User Field 1 (Clock-In Call Type)

  • User Field 2 (Clock-Out Call 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

  • Medicaid Number

  • Payer ID

  • Procedure Code

  • Schedule End Time

  • Schedule ID

  • Schedule Start Time

In alignment with the 21st Century Cures Act mandate, effective May, 23, 2022, visits will be required to split at midnight if the visit crosses multiple calendar days. Overnight visits that do not meet the requirements specified below will fail to process successfully into the HHAeXchange system.

The following fields need to be split at midnight if the visit crosses multiple calendar days: Schedule Start/End Time, Visit Start/End Time, and EVV Start/End Time.

Sample overnight shift from 1/1/21 11pm to 1/2/21 7am:

  • Visit 1: 1/1/2021; 11pm – 11:59PM

    • Schedule Start: 23:01

    • Schedule End: 23:59

    • Visit Start: 23:01

    • Visit End: 23:59

    • EVV Start: 23:01

    • EVV End: 23:59

  • Visit 2: 1/2/2021; 12:01am – 7am

    • Schedule Start: 00:01

    • Schedule End: 06:58

    • Visit Start: 00:01

    • Visit End: 06:58

    • EVV Start: 00:01

    • EVV End: 06:58

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 Member or the Member's family member/representative and documented
11 Confirmed visit with outside entity and documented
13 New attendant assigned to Member
14 Visit rescheduled
15 Service(s) cancelled or suspended until further notice
16 Updated Member's address and documented
17 Updated Member's phone number and documented
18 Changed verification collection method and documented
19 Timesheet received and signed by supervisor
20 Mutual Case/ or Cluster Case/ or Live-in Case
21 Change in schedule
22 Unverified visit; this service cannot be billed
23 Supervisor approved change
25 Timesheet Verified
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 Member
101 Member won't let attendant use phone
102 Member doesn't have a phone in home
103 Phone in use by member or individual in member's home
104 Member received services outside of the home
105 Member's phone line not working (technical issue or natural disaster)
106 Member requested to change/cancel scheduled visit; or the scheduled visit has been cancelled due to the Member's services being suspended
107 Address did not link to the Member (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 or task discrepancy/task does not match plan of care
113 Attendant entered invalid fixed location device code(s)
114 Attendant failed to report to Member'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