Purpose
This article explains how to configure and manage Electronic Visit Verification and Electronic Data Interchange workflows in CareSmartz360.
Use this article when setting up:
Electronic Visit Verification, also called EVV
Electronic Data Interchange, also called EDI
Alternate EVV or third-party EVV vendor connections
Sandata
HHAeXchange, also searched as HHA Exchange
TELUS Health, also searched as TELUS, Mobile Caregiver+, or Mobile Caregiver Plus
Clearinghouse and state-payer billing profiles
EVV payer programs, procedure codes, task mapping, and client or caregiver requirements
EDI claim files, including 837 Professional and 837 Institutional files
The overall process includes registering with the applicable aggregator or payer, configuring the agency and billing settings, completing payer and profile requirements, managing visits, and generating EDI files when applicable.
Important: Requirements vary by state, payer, program, aggregator, and transmission method. Use the applicable aggregator information hub, payer companion guide, state companion guide, or clearinghouse payer list to verify the exact values required for your agency.
Before You Begin
Complete the following prerequisites before creating schedules that will be submitted through EVV or billed through EDI.
1. Identify your reporting requirements
Confirm:
The state and program under which services will be provided
The payer receiving claims
The EVV aggregator receiving visit data
Whether the integration uses an API connection or a file-upload process
Whether claims will be sent through a clearinghouse or directly to a state payer
Whether the payer requires 837P or 837I claim files
The procedure codes, modifiers, units, and task codes required by the payer or aggregator
Aggregator and registration requirements may differ by state.
2. Gather the required agency information
Depending on the aggregator, payer, and connection type, you may need:
Employer Identification Number, or EIN
Tax ID
National Provider Identifier, or NPI
State Medicaid provider ID
Trading partner number
Submitter ID
Sender and receiver IDs
Agency address, including the complete ZIP+4 when required
SFTP host, port, username, password, and folder information
Payer-issued or clearinghouse-issued payer IDs
Procedure codes and modifiers
EVV task codes
Contact information for the individual responsible for submissions
EIN or Tax ID, NPI, Medicaid ID, address, sender and receiver details, and SFTP credentials are possible configuration elements.
3. Register with the EVV aggregator
The provider is responsible for completing the applicable aggregator registration before CareSmartz360 can finish the required system configuration.
HHAeXchange: Use the HHAeXchange Provider Information Hub for your state and program. Complete the applicable enrollment process. Depending on the state, HHAeXchange may issue production credentials for an API integration or use a file-upload process.
Sandata: Complete the applicable provider registration process for your state. Self-registration is available only for certain states. State-specific registration instructions may be required when self-registration is unavailable.
TELUS Health or Mobile Caregiver+: Register for the applicable state or payer program. If your agency already has an account, additional registration may not be necessary, but CareSmartz360 must still be notified so the required configuration request can be submitted.
If you are onboarding, notify your onboarding contact after registration. Otherwise, contact CareSmartz360 Support through the in-system chat so the necessary configuration request can be initiated.
Recommended Order of Operations
Complete the setup in the following order:
Register with the aggregator or payer.
Complete the agency-level EVV configuration.
Create the billing or clearinghouse profile for EDI.
Configure the payer’s EVV and EDI settings.
Add procedure codes and billing rates.
Complete task mapping, when required.
Complete each client’s demographic, payer, diagnosis, and authorization information.
Complete applicable caregiver information.
Create schedules and associate the correct services and care-plan tasks.
Manage and approve completed visits.
Process billing when required by the aggregator workflow.
Post EVV visit data or generate the EDI claim file.
Correct validation errors or payer rejections and regenerate the file when appropriate.
Task mapping should be completed before schedules are created and connected to care plans so that tasks can be reported accurately.
Part 1: Configure EVV at the Agency Level
Agency EVV configuration stores the provider information needed for the selected aggregator or transmission process.
Instructions
Select Settings.
Select See All Settings.
Select Agency.
Select EVV Configuration.
Select the applicable aggregator.
Select the office you are configuring.
Enter the required provider information.
If the agency has more than one Medicaid provider ID, select Add Additional Information and add the additional profile.
Save the configuration.
For HHAeXchange file-upload configurations, the requested information may include the EIN, NPI, and state Medicaid ID. TELUS configurations may require Tax ID, Medicaid ID, and NPI information, in addition to configuration completed by CareSmartz360.
Important Consideration
Some integrations are configured by CareSmartz360. File-upload workflows may require the agency to complete additional fields directly in its account. Do not enter unverified identifiers or credentials. If a configuration section is unavailable or the required values are unclear, contact Support or your onboarding specialist.
Part 2: Create the EDI Clearinghouse or State-Payer Profile
A billing information profile must be created for EDI, including when claims are being submitted directly to a state payer.
Instructions
From Settings, open Billing Information.
Select Add Billing Information.
Select the applicable clearinghouse or direct state-payer profile.
Enter a recognizable Profile Name.
Set the entity type to Company, when the submitter is an organization.
Enter the provider information:
Company name
NPI or other applicable provider identifier
EIN or Tax ID
Full address
ZIP+4, when required
Review the sender and receiver IDs.
If the selected profile does not populate the needed IDs, enter the trading partner number, provider ID, or other values specified by the payer or companion guide.
Enter the submitter information:
Company name
Contact name
Email address, telephone number, fax number, or other required contact method
If EDI files will be sent through SFTP, enter:
Host
Port
Username
Password
Folder name
Save the profile.
Selecting a clearinghouse or state-payer profile may populate certain sender and receiver information. The payer’s or state’s companion guide should be used when values must be entered manually.
Best Practice
Use a profile name that clearly identifies the clearinghouse or state payer. If multiple offices or payer connections are configured, include enough information to distinguish the correct profile during payer setup.
Part 3: Configure the Payer for EVV and EDI
The payer profile connects the payer to the correct clearinghouse, EDI payer ID, EVV aggregator, procedures, and rates.
A. Configure EVV Integration and EDI Values
Open the applicable payer profile.
Locate the EVV Integration section.
Enter the EDI Payer ID issued by the payer or clearinghouse.
Select the appropriate claim type:
837P for professional claims
837I for institutional claims
Select the clearinghouse profile created in Part 2.
Enter the required EVV Payer ID.
Select the applicable EVV aggregator.
Save the payer profile.
The EDI payer ID may be available in the clearinghouse’s payer list. For HHAeXchange, the applicable EVV payer value may be listed in the state’s technical specifications under the managed-care organization or payer information.
Choosing a Claim Type
There are two choices, please confirm with your payer or clearinghouse; they are not the same:
837P: Professional
837I: Institutional
Do not select the claim type based only on the service name. Confirm the required transaction with the payer or clearinghouse. Institutional is normally associated with services provided in an institutional setting, such as a hospital or care facility.
B. Add Procedure Codes and Billing Rates
Except for the Sandata payer-program workflow described later in this article, procedure or billing codes are configured in the payer profile.
Open the payer’s Billing and Rates section.
Select the option to add a procedure code.
Select the applicable service type.
Select the billing or reporting unit, such as:
15-minute increments
Units
Hours
Visits
Enter the required procedure code.
Add modifiers when required.
Select the appropriate description.
Confirm the billing rate.
Save the procedure code.
Use the payer, state, or aggregator documentation to verify the correct code, description, modifier, and unit. Incorrect or missing mappings may cause EVV or EDI errors.
Part 4: Map Care Tasks to the EVV Aggregator
Some states and aggregators require care-plan or assessment tasks to be mapped to aggregator-specific task codes.
When to Complete Task Mapping
Complete task mapping:
After the aggregator has been identified
Before schedules are created
Before mapped tasks are associated with client care plans
Before visits containing those tasks are submitted
Task mapping is a setup activity that should be completed before schedules are created and connected to care plans.
Instructions
Open Settings.
Navigate to the Client Management Section.
The Task Sections are found under DDM - Client Management
Open the appropriate task-management area:
Companion Care Tasks Management
Personal Care Tasks Management
Transportation Needs Tasks Management
Locate the task.
Select Edit.
Select Configure Task Codes.
Select the code that corresponds to the task for the applicable aggregator.
Save the task.
Repeat for each task that must be reported.
Best Practice
Map a system task only to the aggregator task that represents the same activity. Do not choose a code only because it appears similar. Verify unclear mappings against the aggregator’s documentation or with CareSmartz360 Support.
Part 5: Complete the Client Profile
Client information must match the values maintained by the payer and aggregator.
A. Complete the Main Profile Information
Verify the following:
Date of birth
Gender
Medicaid ID or patient ID
The date of birth and member identifier should match the information maintained by the payer or aggregator.
B. Add a Primary Diagnosis or Claim Code
Open the client’s Billing Information and Settings.
Add the applicable diagnosis or claim code.
Mark the appropriate code as Primary.
Save the record.
A primary diagnosis or claim code is required for EDI and for reporting to HHAeXchange, TELUS, and CareBridge. It may not be required for Sandata visit posting, please confirm with your payer.
C. Configure the Client Payer
Open the client’s Billing Information and Settings.
Edit the applicable payer.
Enter the member ID expected by the payer.
Select the appropriate claim filing indicator.
Save the payer information.
MC Medicaid is an applicable claim filing indicator for Medicaid and a Veterans Administration plan is available for applicable VA workflows. Other selections should be based on payer instructions.
D. Add the Client Authorization
Add or edit the client authorization.
Enter the authorization number issued by the payer or aggregator.
Enter the authorization start and end dates.
Enter the approved number of hours or units.
Select the correct service or procedure code.
Enter or confirm the billing rate.
Save the authorization.
The authorization’s service, procedure code, units, and rate should align with the payer configuration. Missing or mismatched mappings may result in validation or submission errors.
Part 6: Configure Sandata Payer Programs
For the Sandata workflow, EVV payer programs and their reporting codes are configured at the client-payer level rather than through the payer-level procedure-code process described earlier.
Instructions
Open the client profile.
Select Billing Information and Settings.
Edit the applicable payer.
Turn on Payer Programs Required for EVV.
Select the applicable payer.
Add the required payer program.
Mark one payer program as Primary.
Add any other applicable payer programs.
Save the client payer.
Available payer programs are specific to the state, program, and services being provided. They may include modifiers required for EVV reporting.
Best Practice for Multiple Sandata Programs
When multiple authorizations or programs apply, we recommend marking the program with the highest authorized number of hours as primary, then adding the remaining programs. Confirm that this approach aligns with your agency’s current program and payer requirements.
Part 7: Complete Applicable Caregiver Information
Caregiver requirements may vary by aggregator and state.
Review the caregiver profile for:
Email address
Social Security number, when required by the applicable program
Date of birth
Hire date
Caregiver type
State ID or caregiver license number
For the HHAeXchange API example, the caregiver type is set to Both, and a state ID or caregiver license number is required.There is also a default-value option when no license number is available. Because identifier requirements are aggregator-specific and may involve sensitive information, verify the currently accepted value with the aggregator or CareSmartz360 Support before entering a placeholder.
Part 8: Manage Completed Visits
After the integration, agency, payer, client, caregiver, and scheduling information is in place, completed visits are managed from Time Tracking Views.
Instructions
Select Scheduling.
Select Time Tracking Views.
Select the date range.
Apply office, client, caregiver, status, or other available filters as needed.
Review the visit information.
Correct incomplete or inaccurate visit data.
Approve the schedule when it is ready for the next step.
Document Manual Visit Edits
When manually changing clock-in or clock-out information:
Open the applicable clock-in or clock-out entry.
Enter the corrected information.
Select the EVV visit-edit reason required by the aggregator.
Select the action taken.
Save the change.
Confirm that the visit displays the manual-entry information.
Manual clock-in or clock-out edits require an aggregator-specific reason code. Examples of actions include Timesheet Verified and Timesheet on File. Select the option that accurately reflects the documentation used by your agency.
Part 9: Complete the EVV and Billing Workflow
The step required before posting visit data depends on the aggregator.
Sandata Workflow
For the Sandata workflow:
Review the completed visit.
Correct any required visit details.
Add edit-reason information when a manual change was made.
Approve the schedule.
Continue with the applicable Sandata posting process.
Schedule approval is required before visit data is posted and Sandata does not process claims as part of this aggregator workflow.
HHAeXchange and TELUS Workflow
For the HHAeXchange and TELUS workflows:
Review and approve the completed visits.
Process billing.
Confirm that the visits are included on the invoice.
Continue with the applicable visit-posting process.
Billing must be processed before visit information can be posted for these workflows.
Part 10: Generate an EDI Claim File
Generate the EDI file after the applicable visits have been reviewed, approved, and billed.
Instructions
Select Accounting.
Select View EDI.
Select the office.
Select the payer.
Select the date type used for filtering, such as service date or invoice date.
Enter the applicable date range.
Select Apply.
Select the invoice or invoices to include.
Select Generate EDI.
Review any validation results.
If validation succeeds, retrieve the preformatted EDI file generated by the system.
Submit the file using the method required by the payer or clearinghouse.
EDI invoices are generated by office and payer.
[Screenshot placeholder: Accounting menu with View EDI selected]
Suggested annotation: Highlight View EDI.
[Screenshot placeholder: EDI invoice filters]
Suggested annotations: Highlight Office, Payer, Date Type, Date Range, and Apply.
[Screenshot placeholder: Available invoices and Generate EDI button]
Suggested annotations: Highlight the invoice-selection checkbox and Generate EDI.
Pre-Generation Validation
Before producing the file, CareSmartz360 validates the available information. Missing procedure codes and missing claim or diagnosis codes are examples of errors that may prevent generation.
When errors appear:
Review the affected client and the error message.
Open the client profile from the available client link or return to the applicable setup area.
Correct the missing or inaccurate information.
Return to View EDI.
Apply the filters again.
Attempt to generate the file again.
Correct or Regenerate an EDI File
Use the generated-file history when a payer rejection requires a corrected or replacement claim.
Instructions
Select Accounting.
Open Generated EDI.
Select the payer.
Enter the applicable invoice-date range.
Locate the previously generated EDI file.
Open the generated file record.
Make the required corrections in the source client, payer, authorization, visit, or billing information.
Return to the generated file.
Select the appropriate regeneration option.
Replacement Claims
Use the replacement option only when required by the payer. Replacement regeneration may require the original Internal Control Number, or ICN, or the previous claim number so that the corrected file references the original claim.
Common Scenarios
Scenario 1: The agency has more than one Medicaid provider ID
Use Add Additional Information in the agency EVV configuration to create the additional provider profile. Confirm that each profile is associated with the appropriate office, state, and program.
Scenario 2: The agency already has a TELUS account
Do not register for another account solely to initiate configuration. Notify CareSmartz360 Support or your onboarding specialist so the required backend configuration request can be submitted.
Scenario 3: Sandata services use multiple payer programs
Add the applicable payer programs to the client payer and identify one as primary. Ensure each authorization points to the correct service and program.
Scenario 4: A staff member manually changes a clock time
Enter the reason code and action taken when saving the manual change. Keep the supporting timesheet or other verification according to your agency’s policies.
Scenario 5: Generate EDI displays missing-code errors
Review the client’s primary diagnosis or claim code, payer information, authorization, and service-to-procedure-code mapping. Correct the source information before attempting to generate the file again.
Scenario 6: A payer rejects a previously submitted claim
Follow the payer’s instructions to determine whether the claim should be corrected, replaced, or otherwise resubmitted. If replacement is required, enter the original ICN or claim number when prompted.
Best Practice Recommendations
Recommended Practices
Complete aggregator registration before requesting system configuration.
Confirm requirements separately for each state, payer, program, and office.
Complete task mapping before creating schedules and care plans.
Use the exact member, Medicaid, payer, provider, and authorization identifiers maintained by the receiving organization.
Keep payer procedures, client authorizations, schedule services, units, and rates aligned.
Use the reason code that accurately describes each manual visit edit.
Review and approve visit information before billing or posting.
Resolve validation errors at their source rather than repeatedly attempting to generate the same file.
Mask client, caregiver, provider, and transmission credentials in screenshots and training materials.
Retain payer and aggregator documentation with your internal configuration records.
Advantages
Completing the setup in order reduces missing dependencies.
Consistent identifiers and mappings support more accurate EVV and EDI submissions.
Pre-generation validation helps identify missing information before the EDI file is created.
Documented reason codes provide context for manual visit changes.
Considerations
Requirements are not identical among Sandata, HHAeXchange, TELUS, states, programs, and payers.
A configuration that works for one office or program may not apply to another.
Payer companion guides and aggregator technical specifications may change.
Replacement claims should not be generated unless the payer’s correction process requires them.
Personally identifiable information and system credentials must be handled securely.
Troubleshooting
EVV Configuration Is Not Available
Possible cause: The configuration may require activation or backend setup.
Resolution: Confirm that aggregator registration is complete, then contact CareSmartz360 Support or your onboarding specialist.
The Correct Aggregator, State, or Program Is Missing
Possible cause: The applicable connection may not yet be configured.
Resolution: Verify the agency’s enrollment and provide Support with the state, payer, program, office, and aggregator information.
An EDI Payer ID Is Rejected
Possible cause: The ID may not match the selected clearinghouse or payer.
Resolution: Verify the ID in the clearinghouse payer list or payer companion guide. Confirm that the correct clearinghouse profile is selected.
The EDI File Cannot Be Generated
Possible causes include:
Missing procedure code
Missing primary diagnosis or claim code
Incomplete client payer information
Missing authorization information
Incorrect service-to-procedure-code mapping
Resolution: Review the displayed error, correct the affected source record, and attempt generation again.
A Visit Does Not Post
Review:
Whether the schedule is approved
Whether billing was processed when required
The client’s member or Medicaid ID
The EVV payer and aggregator selections
Service and procedure-code mappings
Authorization dates and units
Required task mappings
Manual-edit reason information
A Replacement Claim Cannot Be Completed
Confirm that:
The payer requires a replacement claim
The original ICN or claim number is available
The underlying rejection has been corrected
The correct payer and generated file were selected
Associated Reports and Operational Views
Make note of the following operational views:
Time Tracking Views: Used to filter, review, correct, and approve visit information.
View EDI: Used to filter eligible invoices and generate EDI files.
Generated EDI: Used to locate previously generated files and access correction or replacement options.
If your organization uses additional reconciliation, rejection, billing, or visit-status reports, add them here after confirming their names and intended uses.
Related Articles
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Need Assistance?
If a required field, identifier, procedure code, task mapping, or connection value is unclear, contact CareSmartz360 Support through the chat option in your system.
Agencies that are still onboarding can also contact their onboarding specialist.
Please also join one of our EVV/EDI webinars, or the Daily Q&A.