Wellcare of Hawaii BH Code Table

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
16982	Wellcare of Hawaii BH

Visit Edit Code Tables Closed

The following tables provide the codes and descriptions for the Visit Edit Reason Code and the Visit Edit Action Taken fields (as well as the Cancel Missed Visit Reason and Cancel Missed Visit Action Taken) for the following EDI Import Interface files: Confirmed Visits and Billed Visits.

Visit Edit Reason Codes Closed

Visit Edit Reason Codes
Code	Description
100	Phone number did not link to the client.
101	Client won’t let attendant use phone.
102	Client does not have a phone in home.
103	Phone in use by client or individual in member’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 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 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

Visit Edit Action Taken Codes Closed

Visit Edit Action Taken
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 Cas
23	Change in schedule
24	Other

Missed Visit Code Tables Closed

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

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

Missed Visit Reason Codes Closed

Missed Visit Reason Codes
Code	Description
600	Agency unable to provide replacement coverage (no show, no replacement)
601	Attendant failed to report to client’s home
602	Member requested to change/cancel scheduled visit; or the scheduled visit has been cancelled due to the client's services being suspended
616	Other

Missed Visit Action Taken Closed

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

Required Fields by Import File Type Closed

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:
Schedule	Agency Tax ID Payer ID Medicaid Number Caregiver Code Schedule ID Procedure Code Schedule Start Time Schedule End Time
Confirmed Visit	Agency Tax ID Payer ID Medicaid Number Caregiver Code Caregiver First Name Caregiver Last Name Caregiver SSN Schedule ID Procedure Code Schedule Start Time Schedule End Time Visit Start Time Visit End Time Clock-In Service Location Address Clock-Out Service Location Address 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 Payer ID Medicaid Number Caregiver Code Caregiver First Name Caregiver Last Name Caregiver SSN Schedule ID Procedure Code Schedule Start Time Schedule End Time Visit Start Time Visit End Time Clock-In Service Location Address Clock-Out Service Location Address Invoice Number 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.
Rebilled Visit	Agency Tax ID Payer ID Medicaid Number Caregiver Code Caregiver First Name Caregiver Last Name Caregiver SSN Schedule ID Procedure Code Schedule Start Time Schedule End Time Visit Start Time Visit End Time Clock-In Service Location Address Clock-Out Service Location Address Invoice Number Submission Type TRN Number 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.
Missed Visit	Agency Tax ID Payer ID Medicaid Number Caregiver Code Schedule ID Procedure Code Missed Visit Reason Code Missed Visit Action Taken Code Missed Visit (Value should be "Y")
Delete a Schedule	Agency Tax ID Payer ID Medicaid Number Caregiver Code Caregiver First Name Caregiver Last Name Caregiver SSN Schedule ID Procedure Code Schedule Start Time Schedule End Time Is Deletion (Value should be Y)