New York Molina 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
56755 Molina Health New York

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 member or the member’s family member/representative and documented

51

New attendant assigned to member (this service cannot be billed)

52

Service(s) cancelled or suspended until further notice (this service cannot be billed)

53

Unverified visit (this service cannot be billed)

54

Visit rescheduled (this service cannot be billed)

55

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

500

Agency unable to provide replacement coverage (no show, no replacement)

501

Attendant failed to report to member’s home

502

Member requested to change/cancel scheduled visit; or the scheduled visit has been cancelled due to the member's services being suspended.

510

Member Refused Service

511

Member Refused Service - original aide on vacation

512

Hospitalization unplanned

513

COVID-19: All other cases where the agency could not staff due to COVID-19

514

COVID-19: Member refused, self-isolating, not receiving service

515

COVID-19: Member refused, receiving service through informal supports

516

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

S5130:U3

PCS LEVEL I MULTIPLE CLIENT

S5130:U1

PCS LEVEL I – 15 MINUTES

S5130:U2

PCS LEVEL I TWO CLIENT

S5130:TV

PCS LEVEL I WEEKEND/HOLIDAY

T1019:TV

PCS LEVEL II WEEKEND/HOLIDAY

T1019:U3

PCS LEVEL II MULTIPLE CLIENT

T1019:U1

PCS LEVEL II BASIC – 15 MINUTES

T1019:U2

PCS LEVEL II BASIC TWO CLIENT

T1019:U4

PCS LEVEL II HARD TO SERVE

T1019:U5

PCS LEVEL II TWO CLIENT HARD TO SERVE

T1020

PCS LEVEL II LIVE-IN

T1020:U2

PCS LEVEL II LIVE-IN TWO CLIENT

T1020:TV

PCS LEVEL II LIVE-IN WEEKEND/HOLIDAY

T1020:U5

PCS LEVEL II LIVE IN TWO CLIENT HARD TO SERVE

T1019:U6

CDPA BASIC – 15 MINUTES

T1019:U8

CDPA ENHANCED

T1019:U7

CDPA TWO CONSUMER

T1019:U9

CDPA TWO CONSUMER ENHANCED

T1020:U6

CDPA LIVE IN

T1020:U8

CDPA LIVE IN ENHANCED

T1020:U7

CDPA LIVE IN TWO CONSUMER

T1020:U9

CDPA LIVE IN TWO CONSUMER ENHANCED

S5125

HHA - 15 MINUTES

S9122

HHA – PER HOUR

S5125:U2

HHA TWO CLIENT – PER 15 MINUTES

S5126

HHA LIVE-IN - PER DIEM (13 HOURS)

S5126:U2

HHA LIVE-IN TWO CLIENT - PER DIEM (13 HOURS)

S9122:U1

ADVANCED HOME HEALTH AIDE PER HOUR

T1030

NURSING CARE IN HOME (RN) PER DIEM (13 HOURS)

S9123

RN – PER HOUR

T1002

RN – 15 MINUTES

T1031

NURSING CARE IN HOME (LPN) – PER DIEM (13 HOURS)

S9124

LPN – PER HOUR

T1003

LPN – 15 MINUTES

S9129

OCCUPATIONAL THERAPY – PER VISIT

S9131

PHYSICAL THERAPY – PER VISIT

S9128

SPEECH THERAPY – PER VISIT

G0237

RESPITORY THERAPY– PER 15 MINUTES

G0238

RESPITORY THERAPY – PER 15 MINUTES

S9470

NUTRITIONAL COUNSELING – PER VISIT

S9127

MEDICAL SOCIAL SERVICES – PER VISIT

T1013

SIGN LANGUAGE/ORAL INTERPRETER – PER 15 MINUTES

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 member or the member’s family member/representative and documented

11

Supervisor approved change

12

Updated member'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 member's address and documented

18

New attendant assigned to member

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

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 will not let attendant use phone.

102

Member does not 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).

130

Consumer Directed Personal Assistance visit.