EVV Vendor ICN E-Form

EVV vendors are required to complete this form in order to initiate the testing process to send ICNs to be included on 837 files generated by CareBridge (Fields 101-104 on the CareBridge Data Integration Specification) Prior to completing this form, vendors should review the ICN technical specification and testing guide under "Additional Documents for Third-Party Vendors" on the Integration site here: http://evvintegration.carebridgehealth.com/

 
 
 

By default, CareBridge expects a unique ICN for each provider/member/authorization/payer/billing period; however, it is possible for vendors to be configured to use the same ICN for multiple billing periods.

 

By default, if a visit crosses midnight across billing periods, and a second ICN is not included, CareBridge will trigger an error. It is possible to turn on functionality for CareBridge to assume that the second ICN field if omitted, should match the first. This should only be used if the same ICN is used for a member/authorization regardless of the date or billing period.

 

As an EVV Vendor I understand all of the following: •    Submitting ICNs as part of data integration is not a required part of the integration specification. CareBridge is capable of generating ICNs associated with claims and makes those available to integrated vendors via SFTP reports •    In order to submit ICNs, CareBridge's ICN Technical Specification must be followed. •    Errors related to vendor submitted ICNs will result prebilling validation errors that can delay or inhibit claims payment for provider agencies. CareBridge may disable Vendor submitted ICNs for a Vendor if there is an excessive quantity of ICN related errors. •    Prior to enabling Vendor submitted ICNs, Vendor must successfully pass ICN-specific Test Cases after the standard testing has been completed