New York EverCare 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
37695 EverCare

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
54 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
2443 PMPM Biling - 1 thru 159 Hours
2443 Skilled Tier 1 PMPM Admin Fee 1-159 Hours
2444 PMPM Biling - 160 thru 479 Hours
2444 Skilled Tier 2 PMPM Admin Fee 160-479 Hours
2445 PMPM Biling - 480+ Hours
2445 Skilled Tier 3 PMPM Admin Fee 480 Hours and Above
S5125 Home Health Aide - 15 minutes
S5126 Home Health Aide - Live-In
S9122 Advanced Home Health Aide
S9123 Nursing - RN per hour - CAP
S9123:GT Nursing, Telephonic, Assessment & Patient Management, 10+ minutes
S9124 Private Duty Nursing - LPN - per hour
S9127 Medical Social Services
S9127:GT Medical Social Worker, Telephonic, Assessment & Patient Management, 10+ minutes
T1000 Private Duty Nursing per hour - CAP
T1001 Nursing - RN Evaluation
T1019:U1 Personal Care Aide Level II Basic
T1019:U2 Personal Care Aide Level II Basic Two Client 1 of 2 Members in Household
T1019:U3 Personal Care Aide Level II Basic Shared (Multiple Members)
T1019:U4 Personal Care Aide Per Hour -Hard to Serve
T1019:U5 Personal Care Aide per hour - Two Consumers Hard to Serve
T1019:U6 CDPA Basic
T1019:U8 CDPA Enhanced
T1020 PCA Level II Live In
T1020:U2 PCA Level II Live In Two Client
T1020:U5 PCA Level II Live In Two Clients Hard to Serve
T1020:U6 CDPA Live in
T1020:U7 CDPA Live in Two Consumers
T1020:U8 CDPA Live in Enhanced
T1020:U9 CDPA Live in Two Consumer Enhanced
T1030 Nursing - RN Visit
T1030:GT RN Supervision, Telephonic Visit
T1031 Nursing - LPN Visit

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:

Billed Visit

  • Agency Tax ID

  • Caregiver Code

  • Caregiver First Name

  • Caregiver Last Name

  • Caregiver SSN

  • Clock-In Service Location Type

  • Clock-Out Service Location Type

  • Invoice Number

  • 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.

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

PMPM Billing

  • Agency Tax ID

  • Caregiver Code - Default to TEMP

  • Invoice Number

  • Medicaid Number

  • Payer ID

  • Procedure Code

  • Schedule End Time

  • Schedule ID

  • Schedule Start Time

  • Visit Edit Action Taken - Default to 11

  • Visit Edit Reason - Default to 130

  • Visit End Time

  • Visit Start Time

Rebilled Visit 

  • Agency Tax ID

  • Caregiver Code

  • Caregiver First Name

  • Caregiver Last Name

  • Caregiver SSN

  • Clock-In Service Location Type

  • Clock-Out Service Location Type

  • Invoice Number

  • Medicaid Number

  • Payer ID

  • Procedure Code

  • Schedule End Time

  • Schedule ID

  • Schedule Start Time

  • Submission Type

  • TRN Number

  • 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

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 Cas
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
27 EVV Exception, Manual Audit Required

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