V5 Flat File Common Import Rejections

To fix the rejection:

1. Confirm that the payer is active and properly set up in HHAeXchange for your agency.

2. If not, submit a ticket to HHAeXchange support to request payer linkage for the agency. You may need to contact your provider representative and request to be added to the provider rooster sent to HHAeXchange.

3. Once confirmed, resubmit the visit.

To prevent this rejection, during onboarding or when new contracts are added, confirm that all active payers are configured and linked to the correct agency NPI and office records.

Allow Auto Placement flag should be enabled at service code level to send placement. Please contact EDI Support to update configurations

To fix the rejection:

1. Submit a ticket to HHAeXchange EDI Support.

2. Include examples of rejected visits along with the service code(s) and payer involved.

3. Request that the Allow Auto Placement flag be reviewed and enabled for the applicable service codes.

While this is ultimately a configuration issue in HHAeXchange, agencies can proactively review their service code setup by going to Admin > Reference Table Management > MCO Service Code in the portal. Confirm which codes:

• Do not require authorizations

• Are correctly flagged for auto-placement

• Reference the Auto Placement by Service Code page for more information.

To fix the rejection:

1. Review the visit’s duration and service type.

2. Enter the correct number of units into the Billed Units field.

3. Resubmit the visit with complete billing data.

To prevent this rejection, validate that the Billed Units field is not left blank or set to zero before allowing visit export.

Billed Units Do Not Match Recorded Hours – Cannot Be Processed for Billing

This rejection reason happens when the units billed in the visit file do not align with the actual time recorded by the caregiver based on clock-in and clock-out. This mismatch prevents the visit from being processed for billing.

To fix the rejection:

1. Review the visit’s recorded duration and confirm how it should be translated into billing units (e.g., 1 unit = 15 minutes).

2. Update the visit with corrected units or adjust clock-in/out times if needed.

3. Resubmit the visit.

To prevent this rejection, ensure your EVV system calculates and maps units accurately based on your payer’s billing increment (e.g., 15, 30, or 60 minutes).

This rejection reason happens when this error occurs when HHAeXchange identifies more than one patient profile with the same Medicaid ID, and a placement cannot be created because the system doesn’t know which record to associate the visit with. This is often the result of duplicate patient records with different Start of Care (SOC) dates.

To fix the rejection:

1. Log in to the HHAeXchange portal and navigate and verify the SOC date for each duplicate profile and identify the one that aligns with the visit being submitted.

2. If the visit occurred before the SOC date, update the SOC to match the earliest visit start date. To update go to MCOs/ Insurance > Search for the patient > Click the three dots > Edit Service Start Date.

3. Resend the visits after the update is saved.

To prevent this rejection, regularly review patient records for duplicate profiles and keep SOC dates up to date. Establish an internal process to check the member’s SOC before submitting visits.

To fix the rejection:

1. Update the caregiver profile in your agency management system to include the SSN.

2. Resend any rejected visits.

To prevent this rejection, adjust caregiver setup workflows to require SSN as part of the onboarding or data entry process. This ensures critical fields are not missed before caregivers are linked to visits.

To fix the rejection:

1. Ensure mobile devices have location services enabled and functioning.

2. If GPS is not captured, send a visit edit with the appropriate Visit Edit Code.

To prevent this rejection, confirm that GPS is enabled and functional before each shift. Provide staff with device usage guidelines to reduce the risk of GPS capture failures.

To fix the rejection:

1. Review and correct the phone number to ensure it contains only 10 numeric digits.

2. Remove any extra characters or formatting symbols.

3. Resubmit the visit file.

To prevent this rejection, apply formatting rules in your EVV system to limit Clock-In/Out phone numbers to exactly 10 digits and remove non-numeric characters.

This rejection reason happens when The visit was submitted without a Clock In Service Location Type (e.g., Home or Community), which is a required field for EVV compliance when the visit is confirmed or billed, depending on your state’s requirements.

To fix the rejection:

1. Update the visit record to include the Service Location Type.

2. Resubmit the visit with the correct value based on where the care was delivered.

To prevent this rejection, ensure your EVV system captures and exports Location Type at the appropriate stage based on visit status (scheduled, confirmed, billed). Reference the Required Fields by Import Type section under your state’s EDI Code Table Guide to confirm when the field is required.

To fix the rejection:

1. Search for the caregiver in the HHAeXchange portal using their SSN.

2. If the existing profile is valid, update the Alternate Caregiver Code in HHAeXchange to match the value being sent in the visit file.

3. If multiple caregivers need to be updated, request a Caregiver Bulk Import Process to perform a bulk update of codes.

4. Resubmit the visit using the correct caregiver profile.

To prevent this rejection, if you’re changing EVV systems, ask your vendor if they can use your previous caregiver code value from your former system for V5 visit exports.

To fix the rejection:

1. Ensure the Visit Start Time is formatted correctly per the V5 file specifications for your state.

2. If exporting from a report, save the file directly without opening it to avoid formatting issues.

3. Resubmit the corrected visit.

To prevent this rejection, apply consistent formatting rules at export to preserve correct timestamp structure. Provide training on how to export and save files properly from reporting tools.

To fix the rejection:

1. Add missing identifiers in your agency management system.

2. Resend any rejected visits.

To prevent this rejection, make these fields mandatory in your EVV system to prevent future errors.

Missed Visit Edit Reason Code Not Found in HHAeXchange

To fix the rejection:

1. Review the Missed Visit Code list in your state’s EDI Code Table Guide.

2. Replace the invalid reason code with a valid one.

3. Resubmit the visit file with the corrected reason.

To prevent this rejection, limit selectable reason codes in your EVV system to only those included in the state-specific HHAeXchange configuration.

This rejection reason happens when more than one patient in HHAeXchange has the same Medicaid ID. Without an additional unique identifier, the system doesn’t know which record to link the visit to.

To fix the rejection:

1. Update your integration to include the HHAeXchange Admission ID in User Field 4, as outlined in the V5 flat file specifications.

2. This ensures the visit is assigned to the correct patient profile.

3. Resend any rejected visits.

Note: This issue can’t be fully prevented by the agency or vendor, but including the Admission ID in every visit file helps reduce the error when duplicate profiles exist.

Office NPI in Application Does Not Match Data Received in Visit File

This rejection reason happens when the NPI received does not match an office in your portal.

To fix the rejection:

1. Go to Admin > Office Setup in the HHAeXchange portal.

2. Search for the office and confirm the NPI is correct.

3. If the office does not exist or is missing the correct NPI, submit a ticket to have it created and linked to the appropriate payer contract.

To prevent this rejection, align the NPI values in your EVV system exactly with those configured in your portal. If the portal has incorrect or outdated values, update them to reflect what your system is sending.

Overlapping Shifts Are Not Allowed. Your Shift Overlaps with Same Patient/DOS or Same Caregiver/DOS

This rejection reason happens when visit times overlap with another visit.

To fix the rejection:

1. Update visit times to avoid overlaps greater than 1 minute.

2. Resend any rejected visits.

To prevent this rejection, use system alerts to flag overlaps before export.

Patient Diagnosis Code (DX Code) is Required When Visit is Confirmed or Billed

This rejection reason happens when the visit is confirmed or billed, but the patient’s DX Code was not included along with the visit. This is required for claim submission and can result in billing rejections if not provided.

To fix the rejection:

1. Go to the patient’s profile in your agency management system.

2. Enter a valid diagnosis code in the appropriate field.

3. Resend the visit after updating the patient record.

To prevent this rejection, make it part of your intake or onboarding process to add the DX code when setting up a new patient. Periodically review patient records to ensure all required fields, including DX Code, are populated before scheduling visits.

Patient Not Found in HHAeXchange

This rejection happens when the Medicaid ID in the visit file doesn't match any member in HHAeXchange for the specified Payer ID and Office.

To fix the rejection:

1. Search the member by name in the portal.

2. Verify the Payer ID and Office NPI match the EDI Code Table Guide for your designated state.

3. If the patient isn’t loaded, contact your payer contract representative to have the authorization added.

4. Confirm the correct Medicaid ID was sent. Update your agency management system if the Medicaid ID provided does not match the member profile.

To prevent this rejection, validate the member eligibility and ensure the correct Medicaid ID is entered in your system.

Payer ID Should Be Numeric. Refer to the EDI Code Table Guide

This rejection reason happens when the payer ID doesn't match accepted values in the EDI Code Table Guide.

To fix the rejection:

1. Review state-specific Payer ID values in the EDI Code Table Guide.

2. Adjust mappings in your system.

To prevent this rejection, confirm payer ID mappings are kept up to date and align with the EDI Code Table Guide for your designated state.

Payer ID is Required

This rejection reason happens when the Payer ID was missing from the visit file. This typically occurs when the agency management system isn’t configured correctly or fails to include the Payer ID during export.

To fix the rejection:

• Review the visit details and identify the correct payer ID using the EDI Code Table Guide for your state.

• Update your system’s configuration to include the correct payer ID for the associated office and service code.

• Resubmit all visits that were rejected due to this missing field.

To prevent this rejection, ensure that every visit export includes the Payer ID as a required field. Periodically validate your payer mappings and cross-reference against the EDI guide when new payers are added.

Payer is Not Configured for EDI Billing Rates. Please Contact EDI Support to Configure Payer for EDI Billing Rates

To fix the rejection:

1. Confirm whether the payer supports EDI billing rate submissions in your state. You can verify this by referencing the Alternate EVV V5 Flat File page's EDI Payer Configuration and Requirements Tables section.

2. If the payer allows rate management, submit a ticket to HHAeXchange EDI Support requesting that billing rate configurations be enabled for your payer.

3. Ensure your visit file aligns with what’s supported (i.e., if rates are not allowed, remove those fields from your submission).

To prevent this rejection, during onboarding or payer setup changes, confirm whether each payer allows provider-managed rates. Align your EVV file output accordingly to avoid invalid submissions.

Procedure Code is Required

To fix the rejection:

1. Review your state’s EDI Code Table Guide and include the appropriate procedure code in your visit file.

2. Resubmit the visit.

To prevent this rejection, configure your EVV system to require a valid Procedure Code before export.

Procedure Code Not Found in HHAeXchange

To fix the rejection:

1. Check the list of valid procedure codes in the EDI Code Table Guide.

2. Update internal mappings to ensure only approved codes are used.

To prevent this rejection, validate all procedure codes at the point of entry or prior to export to confirm they align with the EDI Code Table Guide.

Schedule Cannot Be Greater Than 24 Hours

This rejection reason happens when the visit’s total duration exceeds 24 hours, which is not permitted under billing and compliance rules. This typically occurs when clock-in/clock-out times are incorrect.

To fix the rejection:

1. Review the visit record and correct the clock-in and clock-out times to reflect actual care provided.

2. If the visit crossed multiple calendar days, split them accordingly into separate visits.

To prevent this rejection, configure your system to validate visit duration before exporting. Any visit over 24 hours should be flagged for review or prevented from export altogether.

Schedule Duration is 0

To fix the rejection, review the visit and update the clock-in and clock-out times to reflect the actual time the caregiver is scheduled with the member.

To prevent this rejection, ensure your EVV system only exports visits after both timestamps have been recorded and verified. Avoid sending placeholder or incomplete time data.

Schedule ID Belongs to a Different Patient in HHAeXchange

To fix the rejection:

1. First, verify if the original claim has been paid:

2. If the claim is paid: Submit a void to the original payer to cancel the visit. Once it’s voided, it is deleted from HHAeXchange and the visit can be resent under the correct payer.

3. If the claim is not paid: Delete the visit from HHAeXchange and then resend it under the correct payer.

To prevent this rejection, before resending visits with a changed payer, always check if the visits is already linked to another patient or payer. Coordinate internally to verify claim status before attempting to resend.

Temp Caregiver Cannot Be Assigned to Confirmed/Billed Visits

To fix the rejection:

1. Reassign the visit to an actual caregiver with an active profile.

2. If the visit is truly a missed visit, update it accordingly using missed visit logic.

3. Resubmit the visit after correction.

To prevent this rejection, avoid using TEMP caregivers for confirmed or billable visits. Ensure your EVV system restricts their use to unverified visits only.

Total Billed Amount Cannot Be Less Than 1

This rejection reason happens when The Total Billed Amount was submitted as $0 or less than $1, which is not allowed when EDI Billing Rate is enabled.

To fix the rejection:

1. Enter the correct billed amount based on payer contracts and service code.

2. Resubmit the visit.

To prevent this rejection, require a minimum billed amount of $1 or more when EDI Billing Rate is active.

Total Billed Amount is Required When EDI Billing Rate is Enabled

To fix the rejection:

1. Review the affected visit record and confirm the billed rate based on your payer contract and service code.

2. Populate the Total Billed Amount field in your agency management system.

3. Resubmit the visit with the billed amount included.

To prevent this rejection, ensure your EVV system is configured to require the Total Billed Amount, Billed Rate, and Units Billed fields together when EDI Billing Rate is enabled. All three fields must be included for the file to be accepted.

TRN Number is Required When Submission Type is Adjustment/Void

To fix the rejection:

1. Locate the original TRN for the visit you are adjusting or voiding.

2. Enter the TRN in the appropriate field in your agency management system.

3. Resubmit the visit file with the correct Submission Type and TRN value.

To prevent this rejection, ensure that your agency’s workflow includes:

• Capturing and storing the TRN from the original billing submission.

• Requiring the TRN field when the Submission Type is marked as Adjustment or Void.

• Blocking exports for these Submission Types if the TRN is missing.

UserField 5 is Required When Submission Type is Adjustment/Void

This rejection reason happens when the visit was submitted as an adjustment or void, but the condition code was left blank. This field is required if corrected claims are sent to NY payer, VNS Choice.

To fix the rejection:

1. Update your system to include the correct value in UserField 5 based on your payer's requirements.

2. Resubmit the rejected visit file.

To prevent this rejection, ensure your system prompts for UserField 5 anytime the Submission Type is marked as Adjustment or Void for the payer VNS Choice.

Visits Cannot Be Imported Prior to Patient SOC Date or After Patient Discharge Date

This rejection reason happens when the visit date falls outside the member’s Start of Care (SOC) or Discharge Date. This can occur when the SOC date in HHAeXchange is outdated or incorrect, or when the member is no longer eligible for services on the date of service (DOS).

To fix the rejection:

1. Search for the patient in the HHAeXchange portal.

2. Navigate to MCOs > Insurance to view the patient’s SOC and Discharge Date.

3. If the visit falls before the SOC date:

   1. Go to MCO Placements > Actions (three dots menu) and select Edit Service Start Date.

   2. Update the SOC to match the earliest visit start date.

4. If the visit falls after the discharge date:

   1. Confirm the member’s eligibility with the payer or your contract manager.

   2. If eligible, request an updated authorization to reflect continued service.

To prevent this rejection, regularly audit member records to ensure SOC and discharge dates are aligned with current eligibility. Maintain communication with your payer to confirm member status, especially for patients with lapses or recent changes in eligibility.

Visit Duration is 0

To fix the rejection, review the visit and update the clock-in and clock-out times to reflect the actual time the caregiver was with the member.

To prevent this rejection, ensure your EVV system only exports visits after both timestamps have been recorded and verified. Avoid sending placeholder or incomplete time data.

Visit Edit Reason Code/Visit Action Taken is Blank and EVV Info is Blank or Has Invalid Value

This rejection reason happens when a visit was submitted but is missing one or more required fields to verify EVV compliance. These include:

• EVV In/Out timestamps

• Service Location

• Call In/Out Type or Verification Method

• Visit Edit Reason Code and Action Taken

This typically occurs when a visit is only partially confirmed, lacks proper EVV verification, or is edited without providing the reason and type of change.

To fix the rejection:

1. Review the V5 specs and EDI Code Table Guide for your state and ensure all required edit fields are included.

2. Provide a valid reason code and action code.

3. Ensure corrected EVV Info fields (clock-in, clock-out, GPS) are accurate and populated.

To prevent this rejection, configure your EVV system to require all applicable fields when submitting visits. Do not allow incomplete edits to be exported without manual verification.

Visit Edit Action Taken Code is Required When Visit Edit Reason Code is Submitted

This rejection reason happens when A visit update or correction was submitted without an Action Taken Code, which is required.

To fix the rejection, refer to your state's EDI Code Table Guide and include the appropriate Edit Visit Action Code when resubmitting the visit.

Visit Edit Reason and Action Taken Codes Are Required When Start/End Times Don’t Match EVV Times

This rejection reason happens when the visit’s manually edited start and end times differ from the original EVV-captured times, but no edit reason code or action taken code was provided. These codes are required to justify any manual changes.

To fix the rejection:

1. Review the visit and provide both a valid Edit Reason Code and Edit Action Code.

2. Refer to your state’s EDI Code Table Guide to choose appropriate values.

3. Resubmit the corrected visit.

To prevent this rejection, configure your EVV system to require both an Edit Reason Code and an Action Taken Code anytime visit start or end times are manually updated. Also ensure that auto-rounding of visit times is disabled in your agency management system to avoid unintentional time changes that require justification.

Visit Edit Reason Code is Required When Visit Edit Action Taken Code is Submitted

This rejection reason happens when A visit update or correction was submitted without an Edit Reason Code, which is required.

To fix the rejection, refer to your state's EDI Code Table Guide and include the appropriate Edit Reason Code when resubmitting the visit.

To prevent this rejection, configure your EVV system to require this field any time a visit edit is made.