Missouri Medicaid: Accrued Units Support
Overview
This release introduces Accrued Units Support for Missouri Medicaid, enabling home care agencies to comply with Missouri's billing rules that allow partial minutes of personal care services to be combined across visits and billed once a full 15-minute unit is reached. The update helps agencies capture eligible leftover service minutes, convert them into billable units when they reach the required threshold, and maintain visibility for EVV validation and audit review. This release introduces support for accrued units for Missouri Medicaid billing and EVV workflows.
What's New
Accrual of Leftover Minutes
The system now captures actual visit minutes, calculates billable units (floor division by 15), and stores remaining minutes as accrued minutes.
Accrual is client-specific and service-type specific — no cross-service or cross-client aggregation.
Leftover minutes are continuously aggregated across visits within the same day.
Automatic Conversion to Billable Units
When accumulated minutes reach ≥ 15, they are automatically converted into a billable unit.
Remaining balance after conversion is retained for further accrual.
Unused accrued minutes are reset at month end and discarded.
EVV Integration — Accrued Minutes Visits (AMV)
A virtual "Accrued Minutes Visit" is generated when a full unit is formed, using Reason Code 280.
AMVs are created with manual call type and a non-overlapping time range.
AMVs are submitted to the EVV aggregator (Sandata) for claims validation.
Prebilling Validation
Validation prevents posting of accrued visits if the schedule is less than 1 full unit.
Schedule overlapping validation ensures non-conflicting time slots.
UI Enhancements
New "Accrued Visit" column on the EVV posting page — visible only for Missouri state.
Consolidated virtual visit display per client showing accrued visit details.
Virtual shift posted details visible on popup.
Schedule start and end times are automatically assigned for available slots.
Audit Trail & Visibility
Full traceability from accrual → conversion → billing at visit, client, and monthly summary levels.
Units sent to Sandata persisted for tracking.
Scope & Limitations
Applies to Missouri Medicaid billing only.
Accrual is limited to the same service within the same calendar month.
Out of scope: Cross-month carry forward, cross-client/cross-service aggregation, retroactive adjustments after claim submission.
North Dakota Medicaid (MMIS) Clearing House Integration
Overview
We are excited to announce the integration of North Dakota Medicaid (MMIS) as a new clearing house within CareSmartz360. This enables agencies operating in North Dakota to generate and submit 837P (Professional) and 837I (Institutional) EDI claim files directly to ND Medicaid — eliminating the need for third-party intermediaries and streamlining the billing workflow.
What's New
New Clearing House: North Dakota Medicaid (MMIS)
A new clearing house option — North Dakota Medicaid — is now available under the Billing Information screen.
Agencies can create a dedicated billing profile for ND Medicaid with the same familiar setup process used for other clearing houses.
837P (Professional) Claim File Support
Generate compliant 837P EDI files for professional claims submitted to ND Medicaid.
Includes proper Rendering Provider details in the 2420A Loop (NM1 segment) with NPI-based provider identification.
Rendering Provider Specialty Information (PRV segment) is automatically generated in the 2420A Loop using the provider's taxonomy code.
837I (Institutional) Claim File Support
Generate compliant 837I EDI files for institutional claims.
Attending Provider Specialty Information is automatically mapped in the 2310A Loop (PRV segment) with the appropriate taxonomy code.
Billing Provider Specialty (Taxonomy Code) Support
The system now includes mandatory Taxonomy Code support for ND Medicaid in the Billing Provider Specialty Information segment (Loop 2000A).
The PRV segment (PRV*BI*PXC*<TaxonomyCode>~) is automatically generated during file creation.
Pre-configured Payer Defaults
Receiver ID: NDDHSMED
Receiver Name: ND MEDICAID
Payer ID (EDI): NDDHSMED — pre-mapped in the Payer Main Tab → EVV Integration section for seamless setup.
How to Set Up
Navigate to Billing Information.
Create a new profile and select North Dakota Medicaid as the clearing house.
Enter the Practice Name (e.g., "North Dakota Medicaid").
Add your agency's Sender ID.
Set Receiver ID to NDDHSMED and Receiver Name to ND MEDICAID.
Configure the Payer with Payer ID (EDI) as NDDHSMED.
Ensure the provider's Taxonomy Code is populated — this is mandatory for ND Medicaid claims.
Save and generate a test EDI file to verify compliance.
Testing & Validation Notes
Per ND MMIS guidelines, the initial trading partner status will be set to Test. Before moving to production submission:
Two valid test files must be submitted per transaction type (837P and 837I).
Each submission will receive an X12C 999 Response File (ACCEPT / REJECT / PARTIAL) .
Once all test files receive an ACCEPT status, ND Medicaid will upgrade your trading partner status to Production.
Washington State Provider One: DAT File Claim Submission
Overview
CareSmartz360 now supports Provider One DAT file generation for Washington State Medicaid claim submissions. Agencies operating in Washington can generate compliant .DAT files directly from CareSmartz360 and upload them to the Provider One portal — following the state's required batch upload format for social service claims with full Electronic Visit Verification (EVV) data.
What's New
New Clearing House: Provider One (Washington State)
A new clearing house option — ProviderOne — is now available in the Billing Information screen.
When Provider One is selected, the system generates files in the state-mandated .DAT format instead of standard` EDI.
Compliant DAT File Format
Files are generated following Washington State's 32-field batch upload specification with:
Caret (^) as the field delimiter (replacing the standard *)
Tilde (~) as the record terminator
Each claim line contains all required elements in the exact order mandated by ProviderOne.
File Naming Convention
DAT files follow the naming pattern: {ProviderID}_{DateTimeStamp}_Care.dat
Example: 768576857_06052026041927_Care.dat
EVV Data Included in Claims
The DAT file now captures and exports complete EVV data per Washington State requirements:
Service start & end times — Actual caregiver clock-in/clock-out times
GPS geo-data — Latitude and longitude for both service start and end locations
Client-provider proximity — Start and end proximity indicators
Client verification — End-time client verification flag (Yes/No)
SSSOP ID — Caregiver identification number
Claim Data Fields Supported
9-digit Billing ProviderOne ID (numeric only)
Client Medicaid ID (up to 20 characters, alphanumeric)
Authorization ID — Mapped from client Billing Info & Settings
Service date range — In mmddyyyy format per ProviderOne requirements
Service code — Primary Procedure Code from the schedule
Modifiers — From client Billing Info & Settings
Units — Numeric unit count
Patient account number — Member ID
Claim frequency type — Supports Original (1), Adjustment (7), and Void (8)
TPL codes and amounts — Third-party liability data
Manual claims indicator / Reason code
Expense Review Widget enhancement - Caregiver portal and mobile app
The Expense Review widget has been enhanced to display all schedules within the selected date range, including schedules that do not have any associated expense entries.
What's Changed?
Previously, only schedules with recorded expenses were displayed.
The widget now also shows schedules where no expenses have been added.
Caregivers can easily identify visits for which expense records are missing and determine whether an expense should be submitted.
Benefits
Improves visibility into expense reporting compliance.
Helps caregivers identify potentially missed expense submissions.
Provides a more complete view of scheduled visits when reviewing expenses.
Reduces the likelihood of unreported reimbursable expenses.
Client Schedule Forms Report – Caregiver Information Added
The Client Schedule Forms PDF has been enhanced to display the assigned caregiver's name in the report header under the new “Caregiver” field. This provides clear visibility into the caregiver who worked the shift and helps agencies maintain more accurate documentation and compliance records.