Virginia 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 table below provides the assigned codes for services/tasks completed during a Patient’s Visit according to their Plan of Care (Duties).

Code Task Name HHAeXchange Category
115 Meal Preparation Personal Care
116 Housework/Chore Personal Care
117 Managing Finances Personal Care
118 Managing Medications Personal Care
119 Shopping Personal Care
120 Transportation Personal Care
122 Hygiene Personal Care
123 Dressing Upper Personal Care
124 Dressing Lower Personal Care
125 Locomotion Personal Care
126 Transfer Personal Care
127 Toilet Use Personal Care
128 Bed Mobility Personal Care
129 Eating Personal Care
130 Bladder Incontinence Personal Care
131 Bowel Incontinence Personal Care
132 Personal Care – General Personal Care
134 Bathing Personal Care
201 In Person Patient Support Activities
202 Via Telephone Patient Support Activities
203 Other Patient Support Activities
401 Shopping (Grocery, Supplies, Personal Items, Etc.) Home Management
402 Travel Accompaniment of Appointments Home Management
403 Housekeeping/Cleaning Home Management
405 Take Blood Pressure Treatment / Special Needs
406 Weigh Patient Treatment / Special Needs
407 Record Output (Urine/BM) Treatment / Special Needs
408 Assist with catheter care Treatment / Special Needs
409 Empty foley bag Daily or when ½ Full Treatment / Special Needs
410 Assist with ostomy care Treatment / Special Needs
411 Remind to take medication Treatment / Special Needs
412 Assist with Treatment Treatment / Special Needs
499 Other Home Management
500 Change bed linen Patient Support Activities
501 PDN-LPN Monitoring Vitals Nursing Care
502 PDN-LPN Nursing Care Nursing Care
503 PDN-LPN Managing Medications Nursing Care
505 Clean Patient Care Equipment Patient Support Activities
506 Do Patient shopping and errands Patient Support Activities
508 Accompany Patient to medical appointment Patient Support Activities
509 Diversional Activities-Speak/Read Patient Support Activities
511 Monitor Patient Safety Patient Support Activities
512 Patient Laundry Patient Support Activities
513 Light Housekeeping Patient Support Activities
599 PDN-LPN Other Nursing Care
601 PDN-RN Monitoring Vitals Nursing Care
602 PDN-RN Nursing Care Nursing Care
603 PDN-RN Managing Medications Nursing Care
699 PDN-RN Other Nursing Care
799 Other Nursing Care

The Payer ID is the unique identifier for each MCO, sent as a required field in the V5 Flat File. The following table provides the MCO/Payer ID Code for each Payer.

Code MCO/Payer
97271 Humana Virginia

The following table provides 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
51 Confirmed with the member or the member's family member/representative and documented (this service cannot be billed)
52 New attendant assigned to member (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)
56 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 Payer
700 Agency unable to provide replacement coverage (no show, no replacement) All
701 Attendant failed to report to client's home All
702 Member requested to change/cancel scheduled visit; or the scheduled visit has been cancelled due to the client's services being suspended All
703 Member Refused Service All
704 Member Refused Service - original aide on vacation All
705 Hospitalization unplanned All
706 COVID-19: All other cases where the agency could not staff due to COVID-19 All
707 COVID-19: Member refused, self-isolating, not receiving service All
708 COVID-19: Member refused, receiving service through informal supports All
709 Other All
Service Code Description  HHAeXchange Service Type 

S5126

 Consumer Directed Personal Assistance/Attendant Care

PCA
S5135 Companion Services (Agency Directed)

COMP
S5150 Consumer-Directed Respite Services

RESP
T1005 Respite Care

RESP
T1019 Personal Care

PCA
0424 Physical Therapy, Home Health Assessment

HCSS
0421 Physical Therapy, Home Health Follow-Up Visit

HCSS
0431 Occupational Therapy, Home Health Follow-Up Visit

HCSS
0434 Occupational Therapy, Home Health Assessment

HCSS
0444 Speech-Language Services, Home Health Assessment

HCSS
0441 Speech-Language Services, Home Health Follow-Up Visit

HCSS
0550 Skilled Nursing Assessment

HCSS
0551 Skilled Nursing Care, Follow-Up Care

HCSS
0559 Skilled Nursing Care, Comprehensive Visit

HCSS
0571 Home Health Aide Visit (no PA required)

HCSS

There are required fields per file document which must be in aspecific 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 Address

  • Clock-Out Service Location Address

  • 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 Address

  • Clock-Out Service Location Address

  • 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

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

  • 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

TPL Billing

  • Agency Tax ID

  • Caregiver Code

  • Caregiver First Name

  • Caregiver Last Name

  • Caregiver SSN

  • Clock-In Service Location Address

  • Clock-Out Service Location Address

  • Enable Secondary Billing

  • Invoice Number

  • Medicaid Number

  • Other Subscriber ID

  • Paid Date

  • Payer ID

  • Primary Payer ID

  • Primary Payer Name

  • Primary Payer Policy or Group Number Plan Type

  • Procedure Code

  • Relationship to Insured

  • Total Paid Amount

  • Total Paid Units

  • Schedule ID

  • Schedule End Time

  • Schedule Start Time

  • Visit Start Time

  • Visit End Time

*Totals for columns BS – BY must add up to total field amount provided.

*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.

The following tables provide the codes and descriptions for the Visit Edit Action Taken fields for the following V5 Flat File 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
26 Other

The following tables provide the codes and descriptions for the Visit Edit Reason fields for the following V5 Flat File 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