Third-Party EVV Vendor Intake

EVV vendors are required to complete this intake form in order to initiate integration activities with CareBridge.


EVV vendors should review the state specific Integration Guide and Technical Specifications for instructions on obtaining credentials for our testing and production environments: http://evvintegration.carebridgehealth.com/

This form is to be completed by EVV vendors only.

If you expect to be working with CareBridge, you will need to contact your EVV Vendor and ask that they fill out this form to initiate the process. CareBridge cannot use responses provided by provider agencies. If you are a provider agency that will be establishing an SFTP integration and submitting data directly to CareBridge rather than your EVV Vendor submitting data on your behalf please select EVV Vendor.

Are you an EVV Vendor or Provider Agency?*

Do not submit this form.

This form is to be completed by EVV vendors only. If you expect to be working with CareBridge, you will need to contact your EVV Vendor and ask that they fill out this form to initiate the process. CareBridge cannot use an intake form that has been completed by a provider agency.

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EVV Vendor Information

This information is used to complete your EVV Vendor profile and confirm the association between you as an EVV vendor and your provider agencies.

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List EVV company name here if not listed in drop down.

This email will be used to send sFTP credentials,

List all Taxpayer Identification Numbers (TIN) for the agencies that will require the exchange of EVV data (separated by ; )

System Compliance

In order to receive credentials for both testing and production, the EVV Vendor system must meet the following requirements below. If a system does not meet these requirements additional development efforts may be required on the EVV Vendor system, a CareBridge representative will reach out if there are any questions relating to EVV Vendor's system capabilities.

Select all applicable EVV transaction types available to system users.

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Location Technology Capability*

When employing any form of EVV (other than IVR or FOB) does the EVV system use location technologies to record the location of the direct care worker at the start and stop of service delivery?

Manual Entry Capability*

In the event of caregiver error, natural disaster, system failure, or when all other forms of entry have been exhausted or are unavailable, does the EVV system have the capability to capture a manual entry? (i.e. Caregiver forgets to clock-out on mobile device, agency administrator can manual enter the caregiver's clock-out time in EVV system.)

Manual Entry Reason*

Is your EVV system capable of requiring provider agencies to provide a reason for the manual entry from a pre-defined list provided by the Health Plan/State Agency?

If you would like to add details for consideration, related to this required functionality being unavailable use the space provided below. (e.g. Development efforts in progress - expected completion 04/01/2021)

Is your EVV system capable of enforcing late or missed visit requirements based on a pre-defined definition of "early", "late", and “missed” defined by the Health Plan/State Agency? (e.g. A visit check-in occurs more than three hours after the scheduled start time = Missed)?

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If you would like to add details for consideration, related to this functionality being unavailable use the space provided below. (e.g. Development efforts in progress - expected completion 04/01/2021)

Is your EVV system capable of capturing an action taken for a "Early", "Late", or "Missed" visit based on a pre-defined list of actions provided by the Health Plan/State Agency? (e.g. Missed Visit/ Action Taken: Caregiver completed visit)?

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If you would like to add details for consideration, related to this functionality being unavailable use the space provided below. (e.g. Development efforts in progress - expected completion 04/01/2021)

Data Capture

Depending on guidelines defined by either the State or Health Plan, CareBridge may require some or all of the follow data fields. From the list below, please indicate all fields that your EVV system IS capable of capturing and transmitting to CareBridge.

Data Capture Cont.

It may be necessary for additional details to be captured and made available to the Health Plan/State Agency via CareBridge.

Is your EVV system capable of capturing and transmitting scheduled appointments prior to visit completion?*

CareBridge requests vendors submit scheduled appointment data prior to completed appointments if available.

At the end of a visit, is your EVV system capable of surfacing pre-defined questions for caregivers to completed?*

Observed Changes are a way for caregivers to indicate any potential changes that the member has experienced that may require follow-up.

You've indicated that your system is capable of capturing 'Observed Changes':*

Is your system capable of sending the questions and corresponding responses to CareBridge?

Care Plans are a way to document member-specific service plan tasks / activities.*

At the end of a visit, is your EVV system capable of documenting the tasks / activities that the caregiver completed during the visit?

You've indicated that your system is capable of capturing 'Care Plan':*

Is your system capable of sending the completed task / activities to CareBridge?

Data Transfer Capabilities

It is important that CareBridge understands your data transfer capabilities and any potential limitations relating to this capability.

Since you have previously integrated with CareBridge, confirm that CareBridge can utilize the same public SSH Key from your previous integration.*
Confirm that you will provide a new public SSH Key to CareBridge.*

email: evvintegration@carebridgehealth.com subject: EVV Vendor Public SSH Key

Are you capable of generating an openSSH formatted public-private key pair to use for authentication?*
You have indicated that you are unable to generate an openSSH formatted public-private key pair to use for authentication. Do you have another mechanism for authentication?*

(CareBridge may reach out for additional details.)

Are you able to transfer EVV data via sFTP on behalf of provider agencies who have selected your system as their EVV solution?*
You have indicated that you are unable to transfer EVV data via sFTP. Are you able to transfer EVV data by another transfer method?*

(CareBridge may reach out for additional details.)

Are you able to use a single sFTP site and credentials for all provider agencies who have selected your EVV solution?*

(sFTP sites and credentials are generally issued at the EVV vendor level)

Indicate the frequency with which you plan to send data to CareBridge.*

List/describe the frequency in which you plan to send data to CareBridge.

EVV Visits/Billing Updates

It is important to CareBridge to provider that provider agencies are kept informed throughout the EVV visit submission and billing process. This information is captured to help ensure that EVV Vendors can supply visit and billing information provided by CareBridge back to their provider agency.

Visit Validations & Claim Statuses*

To help ensure an efficient workflow for providers, CareBridge returns data validation errors as well as billing statuses directly to EVV Vendors. This information is provided as follows: • Pre-Billing Validation Errors via Response File & Pre-Billing Validation Report • Billing Status Updates via Appointment Status Report * For additional information related to Pre-Billing Validations or Billing Details visit: http://evvintegration.carebridgehealth.com/

This information will be returned to EVV Vendors via the Response Files generated from the CareBridge system. Please indicate all methods.

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Please specify intended process

This information will be returned to EVV Vendors via the Daily Pre-Billing Validation Report and Daily Appointment Status Report generated from the CareBridge system. Please indicate all methods.

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Please specify intended process

Section 12006(a) of the 21st Century Cures Act mandates that states implement EVV for all Medicaid personal care services (PCS) and home health services (HHCS) that require an in-home visit by a provider. This applies to PCS provided under sections 1905(a)(24), 1915(c), 1915(i), 1915(j), 1915(k), and Section 1115; and HHCS provided under 1905(a)(7) of the Social Security Act or a waiver.*

Please confirm that your EVV system meets the requirements defined by this Act.

Vendor unable to integrate at this time:

You have indicated that you are unable to meet a key criterion for integration. Please submit this form and then reach out to CareBridge immediately regarding your ability to integrate. evvintegration@carebridgehealth.com

Thank you for completing this intake form.

A member of the CareBridge Integration team will contact you if there are any questions. To access the CareBridge state specific Integration Guide and Technical Specifications and Testing Process Guide go to: http://evvintegration.carebridgehealth.com/

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