Homecare EDI Import
Refer to the layout below when creating the EDI Import file. Contact HHAeXchange Support Team to obtain a copy of the EDI Code Table Guide, specific your Payer(s). This guide contains valid values for certain EDI import fields as indicated below.
^Optional: These fields may be used by the State when evaluating compliance with the 21st Century Cures Act (Cures Act) regulations. The Cures Act mandates that states require EVV use for Medicaid-funded Personal Care Services (PCS) and Home Health Care Services (HHCS) for in-home visits by a provider. For further information, please consult with your states’ specific compliance requirements regarding the Cures Act.
Sample Template: Click EDI Import
Save the *.CSV file on your computer, and Open the file using a text editor (such as Notepad) to preserve the formats for each field. Refer to the Save Sample Templates to a Workstation section.
EVV Visit Import |
|||||
---|---|---|---|---|---|
Field |
Description |
Data Type |
Required |
Max Length |
Cell |
Agency Tax ID |
Tax ID of the Agency |
Numeric |
Required |
10 |
A |
Office NPI |
Agency Office NPI Required When: if service code does not require an authorization and is configured for auto-placement. Refer to the EDI Code Table Guide for your specific Payer(s). The NPI should match the NPI assigned to the member office loaded in HHAeXchange. If the incorrect NPI, this could result in an error. This field is an optional field and can be left blank. |
Numeric |
Situational |
20 |
B |
Payer ID |
Unique MCO/Payer Identifier. Refer to the values defined in the EDI Code Table Guide. |
Numeric |
Required |
10 |
C |
Medicaid Number |
Member identifier - Medicaid Number Format should be alphanumeric with no special characters. |
Text |
Situational |
50 |
D |
Member First Name |
First name of member. |
Text |
Optional |
50 |
E |
Member Last Name |
Last name of member. |
Text |
Optional |
50 |
F |
Member ID |
Unique member ID in agency system. Required when: If not using Medicaid Number Possible values:
|
Text |
Situational |
50 |
G |
Caregiver Code |
Unique ID of the Caregiver in Agency’s Management System. This value is mapped to Alt Caregiver Code field within HHAeXchange. The predefined value TEMP can be included to indicate that there is no Caregiver currently assigned to a schedule. This is allowed only if the visit is not yet verified. |
Text |
Required |
20 |
H |
Caregiver Registry ID |
Unique employee (Caregiver) registered ID with the State. Field is not required for all Payer(s). Refer to the EDI Code Table Guide for your specific Payer(s). |
Text |
Optional |
20 |
I |
Caregiver License Number |
Caregiver State registered license number. Required when: If visit is confirmed or billed. Field is not required for all Payer(s). Refer to the EDI Code Table Guide for your specific Payer(s). |
Text |
Situational |
20 |
J |
Caregiver First Name |
Caregiver’s First Name Required when: If the visit is confirmed or billed status. Situational when: The visit is in a scheduled status, a predefined value TEMP can be included to indicate that there is no Caregiver currently assigned to a schedule. This is allowed only if the visit is not yet verified. |
Text |
Situational |
50 |
K |
Caregiver Last Name |
Caregiver’s Last Name Required when: If the visit is confirmed or billed status. Situational when: The visit is in a scheduled status, a predefined value TEMP can be included to indicate that there is no Caregiver currently assigned to a schedule. This is allowed only if the visit is not yet verified. |
Text |
Situational |
50 |
L |
Caregiver Gender |
Possible Values: M (Male), F (Female), or U (Undefined). If the value is not provided, then “M” is considered the Gender when creating a Caregiver.HHAeXchange recommends sending data in this field.
|
Text |
Optional |
1 |
M |
Caregiver Date of Birth |
Format: YYYY-MM-DD If the value is not provided, then ‘1901-01-01’ is loaded into this field in Caregiver Profile when creating a Caregiver.
|
Date |
Optional |
10 |
N |
Caregiver SSN |
Social Security Number Required when: If the visit is confirmed or billed status.
If you’re unable to send the caregiver SSN please submit a ticket to the Provider EDI Integrations team via the Client Support Portal for further guidance. |
Text |
Situational |
11 |
O |
Caregiver Email |
Employee (Caregiver) Email If blank, then HHAeXchange sends default value of missingemail@altevv.ddd. |
Text |
Optional |
100 |
P |
Schedule ID |
Unique Schedule ID in Agency’s Management System. The Schedule ID should be unique per Member, DOS, Procedure Code and Shift. If the visit crosses multiple calendar days, a unique Schedule ID per calendar day is required. |
Text |
Required |
30 |
Q |
Visit ID |
Unique Visit ID in Agency’s Management System. |
Text |
Optional |
50 |
R |
Procedure Code |
Billing Service Code If the schedule already exists in HHAeXchange, then the Billing Service Code is overwritten (if visit is not billed in HHAeXchange). Refer to the values defined in the EDI Code Table Guide. |
Text |
Required |
50 |
S |
Diagnosis Code |
Patient diagnosis code(s) attributed to the visit. Required when: If visit is confirmed or billed. Format: Pipe (|) separated list of the DX codes; for example: F84.0|B19.10|M87.059.
Field is not required for all Payer(s). Refer to the EDI Code Table Guide for your specific Payer(s). |
Text |
Situational |
208 |
T |
Schedule Start Time |
Schedule Start Time - YYYY-MM-DD HH:MM as per Agency’s Timezone, time must be in military time. If the schedule already exists in HHAeXchange, then the Schedule Start Time is overwritten (if visit is not billed in HHAeXchange).
If schedule hours are less than billed hours, the lesser will be billed. To avoid billing errors, send actuals recorded for the visit Schedule Start/End Times. |
Date /Time |
Required |
16 |
U |
Schedule End Time |
Schedule End Time - YYYY-MM-DD HH:MM as per Agency’s Timezone, time must be in military time.
If schedule hours are less than billed hours, the lesser will be billed. To avoid billing errors, send actuals recorded for the visit Schedule Start/End Times. |
Date /Time |
Required |
16 |
V |
Visit Start Time |
Required when: When Visit End Time OR EVV End Time is provided. Visit Start Time - YYYY-MM-DD HH:MM as per Agency’s Timezone, time must be in military time.
|
Date /Time |
Situational |
16 |
W |
Visit End Time |
Required when: When EVV End Time is provided. Visit End Time - YYYY-MM-DD HH:MM as per Agency’s Timezone, time must be in military time.
|
Date /Time |
Situational |
16 |
X |
EVV Start Time |
EVV Time recorded if visit is confirmed via EVV. Format: YYYY-MM-DD HH:MM as per Agency’s Timezone, time must be in military time. Required when: If visit is confirmed or billed.
|
Date/ Time |
Situational |
16 |
Y |
EVV End Time |
EVV Time recorded if visit is confirmed via EVV. Format: YYYY-MM-DD HH:MM as per Agency’s Timezone, time must be in military time. Required when: If visit is confirmed or billed.
|
Date /Time |
Situational |
16 |
Z |
Clock-In Service Location Address Line 1 |
Member Street Address Required when: If visit is confirmed or billed. Not required when visit is only scheduled.
|
Text |
Situational |
100 |
AA |
Clock-In Service Location Address Line 2 |
Additional Member Street Address |
Text |
Optional |
50 |
AB |
Clock-In Service Location City |
City |
Text |
Situational |
50 |
AC |
Clock-In Service Location State |
State abbreviation |
Text |
Situational |
2 |
AD |
Clock-In Service Location Zip Code |
Zip Code (5 or 9-digit format i.e., 12345). Format: 99999 OR 999999999 |
Text |
Situational |
9 |
AE |
Clock-In Service Location Type |
Possible values: Home or Community Required when: if visit is confirmed or billed. Field is not required for all Payer(s). Refer to the EDI Code Table Guide for your specific Payer(s). |
Text |
Situational |
9 |
AF |
Clock-Out Service Location Address Line 1 |
Member Street Address Required when: If visit is confirmed or billed. Not required when visit is only scheduled. If the value is not provided, then the existing Service Location value in HHAeXchange is removed. |
Text |
Situational |
100 |
AG |
Clock-Out Service Location Address Line 2 |
Additional Member Street Address |
Text |
Optional |
50 |
AH |
Clock-Out Service Location City |
City |
Text |
Situational |
50 |
AI |
Clock-Out Service Location State |
State abbreviation |
Text |
Situational |
2 |
AJ |
Clock-Out Service Location Zip Code |
Zip Code (5 or 9-digit format i.e., 12345). Format: 99999 OR 999999999 |
Text |
Situational |
9 |
AK |
Clock-Out Service Location Type |
Possible values: Home or Community Required when: if visit is confirmed or billed. Field is not required for all Payer(s). Refer to the EDI Code Table Guide for your specific Payer(s). |
Text |
Situational |
9 |
AL |
Duties |
Pipe (|) separated list of the duties; for example: 016|021|023|027 Duty codes can be prefixed by an asterisk (“*”) to indicate task was attempted but refused by Member. e.g. 016|*021|023 Field is not required for all Payer(s). Refer to the EDI Code Table Guide for your specific Payer(s). |
Text |
Optional |
1000 |
AM |
Clock-In Phone Number |
Format: XXXXXXXXXX Required When: Caller ID - If Visit Start Time is confirmed by IVR Field should be left blank if valid phone number was not captured.
|
Numeric |
Situational |
10 |
AN |
Clock-In Latitude |
Latitude - If Visit Start Time is confirmed by GPS
|
Text |
Situational |
50 |
AO |
Clock-In Longitude |
Longitude - If Visit Start Time is confirmed by GPS
|
Text |
Situational |
50 |
AP |
Clock-In EVV Other Info |
Possible Value: FOB
|
Text |
Situational |
25 |
AQ |
Clock-Out Phone Number |
Format: XXXXXXXXXX Required When: Caller ID - If Visit End Time is confirmed by IVR. Field should be left blank if valid phone number was not captured.
|
Numeric |
Situational |
10 |
AR |
Clock-Out Latitude |
Latitude - If Visit End Time is confirmed by GPS
|
Text |
Situational |
50 |
AS |
Clock-Out Longitude |
Longitude - If Visit End Time is confirmed by GPS
|
Text |
Situational |
50 |
AT |
Clock-Out EVV Other Info |
Possible Value: FOB
|
Text |
Situational |
25 |
AU |
Invoice Number |
Invoice Number in Agency’s Management System. Required when: If visit is billed. Visits must be invoiced in accordance with Payer specific billing requirements noted in the Payer Companion Guide.
This field is exported on the 837 in the CLM line and returned in the 835 CLP line. |
Text |
Situational |
20 |
AV |
Visit Edit Reason Code |
Required when: If visit is manually edited. If the value is not provided, then the existing value of Reason in HHAeXchange is not removed. Visit Edit Reason Code will be required if EVV and Visit Start/End Times are different than EVV Start/End Times. Refer to the values defined in the EDI Code Table Guide. |
Numeric |
Situational |
3 |
AW |
Visit Edit Action Taken |
Required when: If visit is manually edited. If the value is not provided, then the existing value of Action Taken in HHAeXchange is not removed. Visit Edit Action Taken Code will be required if EVV and Visit Start/End Times are different than EVV Start/End Times. Refer to the values defined in the EDI Code Table Guide. |
Numeric |
Situational |
2 |
AX |
Visit Edit Made By |
Required when: If a visit is manually edited. Visit edits require the unique identifier of the user, system, or process that made the edit to the visit. If blank, then HHAeXchange sends default value of Agency User. |
Text |
Situational |
100 |
AY |
Notes |
Free Text Notes - Data in this field is imported as Visit Notes. If the value is not provided, then the existing value of Notes in HHAeXchange is not removed. A Note may be required by the Payer when Missed Visit = “Y”. Refer to the EDI Code Table Guide (Missed Visit Code Tables section) for further details. |
Text |
Optional |
1000 |
AZ |
Is Deletion |
Possible Values: Y (Yes) or N (No) A null value is considered as “N”. Ignored if the Visit is confirmed and claim is billed.
|
Text |
Optional |
1 |
BA |
Invoice Line-Item ID |
Unique identifier of the invoice line item in the 3rd party system. Note: This field should be left blank unless vendor is specifically requested by HHAX to provide this information. |
Text |
Optional |
30 |
BB |
Total Billed Amount |
Billed amount in Agency’s Management System. Required when: If visit is sent as original, adjusted, or voided.
|
Numeric |
Situational |
9 |
BC |
Units Billed |
Units billed in Agency’s Management System. Required when: If visit is sent as original, adjusted, or voided. This field must contain whole unit values, cannot contain decimals.
|
Numeric |
Situational |
2 |
BD |
Billed Rate |
Hourly contractual or employee bill rate. Required when: If visit is sent as original, adjusted, or voided. If value is not provided, rates can be managed in provider portal. |
Numeric |
Situational |
9 |
BE |
Submission Type |
Possible Values: Original, Adjustment, or Void Required when:
Is Deletion should be set to 'Y' if a visit is voided or if the visit needs to be excluded from a claim when sent as an adjustment. |
Text |
Situational |
20 |
BF |
TRN Number |
Required when: If visit is adjusted or voided. TRN is not required if claim is billed as Original. |
Text |
Situational |
20 |
BG |
Enable Secondary Billing |
Possible Values: Y/N Checkbox to enable secondary billing. Required when: If secondary billing is enabled. |
Text |
Optional |
1 |
BH |
Other Subscriber ID |
Required when: If secondary billing is ‘Y’. |
Text |
Situational |
80 |
BI |
Primary Payer ID |
Unique MCO/Payer Identifier. Required when: If secondary billing is ‘Y’ |
Text |
Situational |
161 |
BJ |
Primary Payer Name |
Required when: If secondary billing is ‘Y’ Format: Pipe (|) as a separator for entries related to both Payer 1 and Payer 2. |
Text |
Situational |
121 |
BK |
Relationship to Insured |
Required when: If secondary billing is ‘Y’ Format: Pipe (|) as a separator for entries related to both Payer 1 and Payer 2. Possible Values: · 01 (Spouse) · 18 (Self) · 19 (Child) · G8 (Other) |
Text |
Situational |
5 |
BL |
Primary Payer Policy or Group number |
Required when: If secondary billing is ‘Y’ Format: Pipe (|) as a separator for entries related to both Payer 1 and Payer 2. |
Text |
Situational |
101 |
BM |
Primary Payer Program Name |
Primary and Secondary Payer Name Format: Pipe (|) as a separator for entries related to both Payer 1 and Payer 2. |
Text |
Optional |
161 |
BN |
Plan Type |
Required when: If secondary billing is ‘Y’ Format: Pipe (|) as a separator for entries related to both Payer 1 and Payer 2. Possible Values: • BL (Blue Cross/Blue Shield) • CH (Champus) • CI (Commercial Insurance Co.) • MB (Medicare Part B) • MC (Medicaid) |
Text |
Situational |
5 |
BO |
Total Paid Amount |
Total Paid Amount in EOB from primary Payer. Required when: if secondary billing is ‘Y’ Format: Pipe (|) as a separator for entries related to both Payer 1 and Payer 2. |
Numeric |
Situational |
19 |
BP |
Total Paid Units |
Reserved for Future Use Total Paid Units in EOB from primary Payer. Required when: if secondary billing is ‘Y’ Format: Pipe (|) as a separator for entries related to both Payer 1 and Payer 2. |
Numeric |
Situational |
23 |
BQ |
Paid Date |
Paid Date in EOB from primary Payer. Required when: if secondary billing is ‘Y’ Format: Pipe (|) as a separator for entries related to both Payer 1 and Payer 2. Example: YYYY-MM-DD. |
Date |
Situational |
19 |
BR |
Deductible |
Deductible in EOB from primary Payer if available. Pipe (|) as a separator for entries related to both Payer 1 and Payer 2. |
Numeric |
*Situational (see notes below) |
19 |
BS |
Coinsurance |
Coinsurance in EOB from primary Payer if available. Pipe (|) as a separator for entries related to both Payer 1 and Payer 2. |
Numeric |
*Situational (see notes below) |
19 |
BT |
Copay |
Copay in EOB from primary Payer if available. Pipe (|) as a separator for entries related to both Payer 1 and Payer 2. |
Numeric |
*Situational (see notes below) |
19 |
BU |
Contracted Adjustments |
Contracted Adjustments in EOB from primary Payer if available. Pipe (|) as a separator for entries related to both Payer 1 and Payer 2. |
Numeric |
*Situational (see notes below) |
19 |
BV |
Not Medically Necessary |
Not Medically Necessary in EOB from primary Payer if available. Pipe (|) as a separator for entries related to both Payer 1 and Payer 2. |
Numeric |
*Situational (see notes below) |
19 |
BW |
Non-Covered Charges |
Non-Covered Charges in EOB from primary Payer if available. Pipe (|) as a separator for entries related to both Payer 1 and Payer 2. |
Numeric |
*Situational (see notes below) |
19 |
BX |
Max Benefit Exhausted |
Max Benefit Exhausted in EOB from primary Payer if available. Pipe (|) as a separator for entries related to both Payer 1 and Payer 2. |
Numeric |
*Situational (see notes below) |
19 |
BY |
Missed Visit |
Possible Values: Y (Yes) or N (No) A null value is considered as “N”.
|
Text |
Situational |
1 |
BZ |
Missed Visit Reason Code |
Required when: When Missed Visit = “Y” If the value is not provided, then the existing value of Reason in HHAeXchange is not removed. Refer to the values defined in the EDI Code Table Guide. |
Numeric |
Situational |
3 |
CA |
Missed Visit Action Taken Code |
Required when: When Missed Visit = “Y” If the value is not provided, then the existing value of Action Taken in HHAeXchange is not removed. Refer to the values defined in the EDI Code Table Guide. |
Numeric |
Situational |
2 |
CB |
Missed Visit Notes |
Notes. |
Text |
Situational |
1000 |
CC |
Travel Time Request Hours |
Format: HH:MM |
Numeric |
Optional |
5 |
CD |
Travel Time Comments |
Notes. |
Text |
Optional |
500 |
CE |
Cancel Travel Time Request |
Possible Values: Y (Yes) or N (No) |
Text |
Optional |
1 |
CF |
Timesheet Required |
Possible Values: Y (Yes) or N (No) A null value is considered as “N”.
|
Text |
Optional |
1 |
CG |
Timesheet Approved |
Possible Values: Y (Yes) or N (No) A null value is considered as “N”.
|
Text |
Optional |
1 |
CH |
User Field 1 |
Clock- In Call Type Required when: if visit is confirmed or billed. Possible Values:
|
Text |
Situational |
9 |
CI |
User Field 2 |
Clock- Out Call Type Required when: if visit is confirmed or billed. Possible Values:
|
Text |
Situational |
9 |
CJ |
User Field 3 |
HHAeXchange Unique Office ID Required When: If the service code allows for auto-placement and multiple offices share the same office NPI, a unique office ID is required. The Office ID in HHAeXchange can be found under Admin > Office Setup |
Text |
Situational |
8 |
CK |
User Field 4 |
Patient Admission ID Required when: a member is dually enrolled with a health plan and has multiple accounts in HHAeXchange. |
Text |
Optional |
50 |
CL |
User Field 5 |
Condition Codes Required when: If visit is adjusted or voided. Field is not required for all Payer(s). Refer to the EDI Code Table Guide for your specific Payer(s). |
Text |
Optional |
2 |
CM |
User Field 6 |
Claim Filing Code Required when: if secondary billing is ‘Y’ Pipe (|) as a separator for entries related to both Payer 1 and Payer 2. Possible Values: 11 - Other Non-Federal Programs 12 - Preferred Provider Organization (PPO) 13 - Point of Service (POS) 14 - Exclusive Provider Organization (EPO) 15 - Indemnity Insurance 16 - Health Maintenance Organization (HMO) Medicare Risk 17 - Dental Maintenance Organization AM - Automobile Medical BL - Blue Cross/Blue Shield CH – Champus CI - Commercial Insurance Co. DS – Disability Fi - Federal Employees Program HM - Health Maintenance Organization LM - Liability Medical MA - Medicare Part A MB - Medicare Part B MC – Medicaid OF - Other Federal Programs TV - Title V VA - Veterans Affairs Plan WC - Workers' Compensation Health Claim |
Text |
Situational |
5 |
CN |
User Field 7 |
Other Payer Paid Amount Required when: if secondary billing enabled for Payer 2. |
Numeric |
Situational |
9 |
CO |
User Field 8 |
Field in layout for future use Always empty |
Text |
Optional |
500 |
CP |
User Field 9 |
Field in layout for future use Always empty |
Text |
Optional |
500 |
CQ |
User Field 10 |
Field in layout for future use Always empty |
Text |
Optional |
500 |
CR |
-
Optional fields are not required. Situational fields are dependent on other fields and may be required according to the information in another field. For example, if a Missed Visit is marked as Y, then the Situational fields Missed Visit Reason Code and Missed Visit Action Taken Code are required.
-
The last row is considered the latest data and is reflected in HHAeXchange as such. This means values received in the latest record overrides the data in HHAeXchange.
-
The Schedule Start Time and Schedule End Time is updated with Visit Start Time and Visit End Time values if those fields have data in the file.
-
Visit Edit Reason Code and Visit Edit Action Taken is required if visit is manually adjusted or if visit is missing EVV required fields. If not provided, visit record will be rejected.
-
Clock-In Service Location and Clock-Out Service Location is required if visit is confirmed or billed. Note: if not provided, visit record will be rejected.
-
If Visit Start Time and Visit End Time is adjusted, then Schedule Start Time and Schedule End Time should be adjusted to avoid overlapping visits.
-
Notes for columns BS to BY: • *Situational: Total for these fields must add up to total billed amount if provided.