New Schedule
MEDICAID # | First Name | Last Name | Number | Payer | Branch | Action |
---|---|---|---|---|---|---|
{{member.TMHP_INDVMBR_MEDICAIDID}} | {{member.TMHP_INDVMBR_FIRSTNAME}} | {{member.TMHP_INDVMBR_LASTNAME}} | {{member.TMHP_INDVMBR_PHONE}} | {{member.TMHP_INDVMBR_PAYOR}} | {{member.REV_BRANCH}} | ✎ ✖ |
{{currentPage+1}}/{{numberOfPages}}
Visit ID: {{visitVerification.VISIT_VISITID}}
Date | EVVR ID | Status | Field Name | Error Code | Error Description |
---|---|---|---|---|---|
{{error.date}} | {{error.TMHP_EVVRID}} | {{error.status}} | {{error.fieldName}} | {{error.code}} | {{error.desc}} |
Visit ID: {{visitVerification.VISIT_VISITID}}
TIN | NPI | API | TPI | Legal Name | DBA Name | Contact Number | Address 1 |
{{verifiedVisitVerification.PROVIDER_TIN}} | {{verifiedVisitVerification.PROVIDER_NPI}} | {{verifiedVisitVerification.PROVIDER_API}} | {{verifiedVisitVerification.PROVIDER_TPI}} | {{verifiedVisitVerification.PROVIDER_LEGALNAME}} | {{verifiedVisitVerification.PROVIDER_DBA}} | {{verifiedVisitVerification.PROVIDER_CONTRACTNUMBER}} | {{verifiedVisitVerification.PROVIDER_ADDRESS1}} |
Address 2 | City | State | ZIP | Location ID | Region | From Date | To Date |
{{verifiedVisitVerification.PROVIDER_ADDRESS2}} | {{verifiedVisitVerification.PROVIDER_CITY}} | {{verifiedVisitVerification.PROVIDER_STATE}} | {{verifiedVisitVerification.PROVIDER_ZIP}} | {{verifiedVisitVerification.PROVIDER_LOCATIONID}} | {{verifiedVisitVerification.PROVIDER_REGION}} | {{verifiedVisitVerification.PROVIDER_EVVEFFDATE}} | {{verifiedVisitVerification.PROVIDER_EVVENDDATE}} |
Employee Information
Employee ID | VISA PASSPORT | Discipline | First Name | Last Name | EVV ID | Start Date |
{{verifiedVisitVerification.EMPLOYEE_EMPLOYEEID}} | {{verifiedVisitVerification.EMPLOYEE_SOCSEC_VISA_PASSPORT}} | {{verifiedVisitVerification.EMPLOYEE_EMPLOYEEDISCIPLINE}} | {{verifiedVisitVerification.EMPLOYEE_FIRSTNAME}} | {{verifiedVisitVerification.EMPLOYEE_LASTNAME}} | {{verifiedVisitVerification.EMPLOYEE_EVVID}} | {{verifiedVisitVerification.EMPLOYEE_STARTDATE}} |
End Date | EVV User ID | EVV User First Name | EVV User Last Name | CDS EMPLOYER EVVID | CDS EMPLOYER FIRST NAME | CDS EMPLOYER LAST NAME |
{{verifiedVisitVerification.EMPLOYEE_ENDDATE}} | {{verifiedVisitVerification.EMPLOYEE_EVVUSERID}} | {{verifiedVisitVerification.EMPLOYEE_EVVUSERFIRSTNAME}} | {{verifiedVisitVerification.EMPLOYEE_EVVUSERLASTNAME}} | {{verifiedVisitVerification.EMPLOYEE_CDSEMPLOYEREVVID}} | {{verifiedVisitVerification.EMPLOYEE_CDSEMPLOYERFIRSTNAME}} | {{verifiedVisitVerification.EMPLOYEE_CDSEMPLOYERLASTNAME}} |
Member Information
Payer | First Name | Last Name | Member MEDICAID | DOB | EVV ID | Start | End | Priority |
{{verifiedVisitVerification.INDVMBR_PAYOR}} | {{verifiedVisitVerification.INDVMBR_FIRSTNAME}} | {{verifiedVisitVerification.INDVMBR_LASTNAME}} | {{verifiedVisitVerification.INDVMBR_MEDICAIDID}} | {{verifiedVisitVerification.INDVMBR_MEMBERDOB}} | {{verifiedVisitVerification.INDVMBR_MEMBEREVVID}} | {{verifiedVisitVerification.INDVMBR_STARTDATE}} | {{verifiedVisitVerification.INDVMBR_ENDDATE}} | {{verifiedVisitVerification.INDVMBR_PRIORITY}} |
Phone | Alt Phone | Alt Phone 2 | Address Latitude | Address Longitude | Total Authunits | Auth Units Type | Total Auth Units Reamaining | {{}} |
{{verifiedVisitVerification.INDVMBR_PHONE}} | {{verifiedVisitVerification.INDVMBR_ALTPHONE}} | {{verifiedVisitVerification.INDVMBR_ALTPHONE2}} | {{verifiedVisitVerification.INDVMBR_ADDRESS_LATITUDE}} | {{verifiedVisitVerification.INDVMBR_ADDRESS_LONGITUDE}} | {{verifiedVisitVerification.INDVMBR_TOTAL_AUTHUNITS}} | {{verifiedVisitVerification.AUTH_UNITS_TYPE}} | {{verifiedVisitVerification.INDVMBR_TOTAL_AUTHUNITSREMAINING}} | {{}} |
Visit Information
Visit ID | Schedule ID | Visit Date | Visit Time In | Visit Time Out | Visit Hours | Visit Location | SVCGRP |
{{verifiedVisitVerification.VISIT_VISITID}} | {{verifiedVisitVerification.VISIT_SCHEDULEID}} | {{verifiedVisitVerification.VISIT_VISITDATE}} | {{verifiedVisitVerification.VISIT_VISITTIMEIN}} | {{verifiedVisitVerification.VISIT_VISITTIMEOUT}} | {{verifiedVisitVerification.VISIT_VISITHOURS}} | {{verifiedVisitVerification.VISIT_VISITLOCATION}} | {{verifiedVisitVerification.VISIT_SVCGRP}} |
Reason Code
Reason Code 1 | Reason Code 1 Desc | Reason Code 1 Comment | Reason Code 2 | Reason Code 2 Desc | Reason Code 2 Comment | Reason Code 3 | Reason Code 3 Desc |
{{verifiedVisitVerification.EVV_REASONCODE1}} | {{verifiedVisitVerification.EVV_REASONCODE1DESC}} | {{verifiedVisitVerification.EVV_REASONCODE1COMMENT}} | {{verifiedVisitVerification.EVV_REASONCODE2}} | {{verifiedVisitVerification.EVV_REASONCODE2DESC}} | {{verifiedVisitVerification.EVV_REASONCODE2COMMENT}} | {{verifiedVisitVerification.EVV_REASONCODE3}} | {{verifiedVisitVerification.EVV_REASONCODE3DESC}} |
Reason Code 3 Comment | Reason Code 4 | Reason Code 4 Desc | Reason Code 4 Comment | Reason Code 5 | Reason Code 5 Desc | Reason Code 5 Comment | Reason Code 6 |
{{verifiedVisitVerification.EVV_REASONCODE3COMMENT}} | {{verifiedVisitVerification.EVV_REASONCODE4}} | {{verifiedVisitVerification.EVV_REASONCODE4DESC}} | {{verifiedVisitVerification.EVV_REASONCODE4COMMENT}} | {{verifiedVisitVerification.EVV_REASONCODE5}} | {{verifiedVisitVerification.EVV_REASONCODE5DESC}} | {{verifiedVisitVerification.EVV_REASONCODE5COMMENT}} | {{verifiedVisitVerification.EVV_REASONCODE6}} |
Reason Code 6 Desc | Reason Code 6 Comment | Reason Code 7 | Reason Code 7 Desc | Reason Code 7 Comment | Reason Code 8 | Reason Code 8 Desc | Reason Code 8 Comment |
{{verifiedVisitVerification.EVV_REASONCODE6DESC}} | {{verifiedVisitVerification.EVV_REASONCODE6COMMENT}} | {{verifiedVisitVerification.EVV_REASONCODE7}} | {{verifiedVisitVerification.EVV_REASONCODE7DESC}} | {{verifiedVisitVerification.EVV_REASONCODE7COMMENT}} | {{verifiedVisitVerification.EVV_REASONCODE8}} | {{verifiedVisitVerification.EVV_REASONCODE8DESC}} | {{verifiedVisitVerification.EVV_REASONCODE8COMMENT}} |
Reason Code 9 | Reason Code 9 Desc | Reason Code 9 Comment | Reason Code 10 | Reason Code 10 Desc | Reason Code 10 Comment | Overall Reason Code | {{}} |
{{verifiedVisitVerification.EVV_REASONCODE9}} | {{verifiedVisitVerification.EVV_REASONCODE9DESC}} | {{verifiedVisitVerification.EVV_REASONCODE9COMMENT}} | {{verifiedVisitVerification.EVV_REASONCODE10}} | {{verifiedVisitVerification.EVV_REASONCODE10DESC}} | {{verifiedVisitVerification.EVV_REASONCODE10COMMENT}} | {{verifiedVisitVerification.EVV_OVERALLREASONCODE}} | {{}} |
Verification Information
SVC Code | HCPCS Code | Modifier | Visit Date | Created Date Time | Phone | Call In Time | Call Out Time | Actual Hours |
{{verifiedVisitVerification.EVV_SVCCODE}} | {{verifiedVisitVerification.EVV_HCPCS_CODE}} | {{verifiedVisitVerification.EVV_MODIFIER}} | {{verifiedVisitVerification.EVV_VISITDATE}} | {{verifiedVisitVerification.EVV_CREATEDDATETIME}} | {{verifiedVisitVerification.EVV_PHONE}} | {{verifiedVisitVerification.EVV_CALLINTIME}} | {{verifiedVisitVerification.EVV_CALLOUTTIME}} | {{verifiedVisitVerification.EVV_ACTUALHOURS}} |
Pay Hours | Units | Visit Location | Visit Latitude In | Visit Longitude In | Learned Location | Lat Long Match In | Input Method In | Input Method Out |
{{verifiedVisitVerification.EVV_PAYHOURS}} | {{verifiedVisitVerification.EVV_UNITS}} | {{verifiedVisitVerification.EVV_VISITLOCATION}} | {{verifiedVisitVerification.EVV_VISIT_LATITUDE_IN}} | {{verifiedVisitVerification.EVV_VISIT_LONGITUDE_IN}} | {{verifiedVisitVerification.EVV_LEARNED_LOCATION}} | {{verifiedVisitVerification.EVV_LAT_LONG_MATCH_IN}} | {{verifiedVisitVerification.EVV_INPUTMETHOD_IN}} | {{verifiedVisitVerification.EVV_INPUTMETHOD_OUT}} |
Alternative Device Id | Visit Notes | Last Visit Maint | Upload Indicator | Last Upload | Vendor Id | File Export Id | Do Not Export Indicator | Auto Confirm Flag |
{{verifiedVisitVerification.EVV_ALTERNATIVEDEVICEID}} | {{verifiedVisitVerification.EVV_VISITNOTES}} | {{verifiedVisitVerification.EVV_LASTVISITMAINT}} | {{verifiedVisitVerification.EVV_UPLOADINDICATOR}} | {{verifiedVisitVerification.EVV_LASTUPLOAD}} | {{verifiedVisitVerification.EVV_VENDORID}} | {{verifiedVisitVerification.EVV_FILEEXPORTID}} | {{verifiedVisitVerification.EVV_DONOTEXPORTINDICATOR}} | {{verifiedVisitVerification.EVV_AUTOCONFIRMFLAG}} |
Visit Record Indicator | Visit Latitude Out | Visit Longitude Out | Material VM Change | Material VM Field Id | Lat Long Match Out | {{}} | {{}} | {{}} |
{{verifiedVisitVerification.EVV_VISITRECORDINDICATOR}} | {{verifiedVisitVerification.EVV_VISIT_LATITUDE_OUT}} | {{verifiedVisitVerification.EVV_VISIT_LONGITUDE_OUT}} | {{verifiedVisitVerification.EVV_MATERIAL_VM_CHANGE}} | {{verifiedVisitVerification.EVV_MATERIAL_VM_FIELD_ID}} | {{verifiedVisitVerification.EVV_LAT_LONG_MATCH_OUT}} | {{}} | {{}} | {{}} |
TIN | NPI | API | TPI | Legal Name | DBA Name | Contact Number | Address 1 |
{{visitVerification.PROVIDER_TIN}} | {{visitVerification.PROVIDER_NPI}} | {{visitVerification.PROVIDER_API}} | {{visitVerification.PROVIDER_TPI}} | {{visitVerification.PROVIDER_LEGALNAME}} | {{visitVerification.PROVIDER_DBA}} | {{visitVerification.PROVIDER_CONTRACTNUMBER}} | {{visitVerification.PROVIDER_ADDRESS1}} |
Address 2 | City | State | ZIP | Location ID | Region | From Date | To Date |
{{visitVerification.PROVIDER_ADDRESS2}} | {{visitVerification.PROVIDER_CITY}} | {{visitVerification.PROVIDER_STATE}} | {{visitVerification.PROVIDER_ZIP}} | {{visitVerification.PROVIDER_LOCATIONID}} | {{visitVerification.PROVIDER_REGION}} | {{visitVerification.PROVIDER_EVVEFFDATE}} | {{visitVerification.PROVIDER_EVVENDDATE}} |
Employee Information
Employee ID | VISA PASSPORT | Discipline | First Name | Last Name | EVV ID | Start Date |
{{visitVerification.EMPLOYEE_EMPLOYEEID}} | {{visitVerification.EMPLOYEE_SOCSEC_VISA_PASSPORT}} | {{visitVerification.EMPLOYEE_EMPLOYEEDISCIPLINE}} | {{visitVerification.EMPLOYEE_FIRSTNAME}} | {{visitVerification.EMPLOYEE_LASTNAME}} | {{visitVerification.EMPLOYEE_EVVID}} | {{visitVerification.EMPLOYEE_STARTDATE}} |
End Date | EVV User ID | EVV User First Name | EVV User Last Name | CDS EMPLOYER EVVID | CDS EMPLOYER FIRST NAME | CDS EMPLOYER LAST NAME |
{{visitVerification.EMPLOYEE_ENDDATE}} | {{visitVerification.EMPLOYEE_EVVUSERID}} | {{visitVerification.EMPLOYEE_EVVUSERFIRSTNAME}} | {{visitVerification.EMPLOYEE_EVVUSERLASTNAME}} | {{visitVerification.EMPLOYEE_CDSEMPLOYEREVVID}} | {{visitVerification.EMPLOYEE_CDSEMPLOYERFIRSTNAME}} | {{visitVerification.EMPLOYEE_CDSEMPLOYERLASTNAME}} |
Member Information
Payer | First Name | Last Name | Member MEDICAID | DOB | EVV ID | Start | End | Priority |
{{visitVerification.INDVMBR_PAYOR}} | {{visitVerification.INDVMBR_FIRSTNAME}} | {{visitVerification.INDVMBR_LASTNAME}} | {{visitVerification.INDVMBR_MEDICAIDID}} | {{visitVerification.INDVMBR_MEMBERDOB}} | {{visitVerification.INDVMBR_MEMBEREVVID}} | {{visitVerification.INDVMBR_STARTDATE}} | {{visitVerification.INDVMBR_ENDDATE}} | {{visitVerification.INDVMBR_PRIORITY}} |
Phone | Alt Phone | Alt Phone 2 | Address Latitude | Address Longitude | Total Authunits | Auth Units Type | Total Auth Units Reamaining | {{}} |
{{visitVerification.INDVMBR_PHONE}} | {{visitVerification.INDVMBR_ALTPHONE}} | {{visitVerification.INDVMBR_ALTPHONE2}} | {{visitVerification.INDVMBR_ADDRESS_LATITUDE}} | {{visitVerification.INDVMBR_ADDRESS_LONGITUDE}} | {{visitVerification.INDVMBR_TOTAL_AUTHUNITS}} | {{visitVerification.AUTH_UNITS_TYPE}} | {{visitVerification.INDVMBR_TOTAL_AUTHUNITSREMAINING}} | {{}} |
Visit Information
Visit ID | Schedule ID | Visit Date | Visit Time In | Visit Time Out | Visit Hours | Visit Location | SVCGRP |
{{visitVerification.VISIT_VISITID}} | {{visitVerification.VISIT_SCHEDULEID}} | {{visitVerification.VISIT_VISITDATE}} | {{visitVerification.VISIT_VISITTIMEIN}} | {{visitVerification.VISIT_VISITTIMEOUT}} | {{visitVerification.VISIT_VISITHOURS}} | {{visitVerification.VISIT_VISITLOCATION}} | {{visitVerification.VISIT_SVCGRP}} |
Reason Code
Reason Code 1 | Reason Code 1 Desc | Reason Code 1 Comment | Reason Code 2 | Reason Code 2 Desc | Reason Code 2 Comment | Reason Code 3 | Reason Code 3 Desc |
{{visitVerification.EVV_REASONCODE1}} | {{visitVerification.EVV_REASONCODE1DESC}} | {{visitVerification.EVV_REASONCODE1COMMENT}} | {{visitVerification.EVV_REASONCODE2}} | {{visitVerification.EVV_REASONCODE2DESC}} | {{visitVerification.EVV_REASONCODE2COMMENT}} | {{visitVerification.EVV_REASONCODE3}} | {{visitVerification.EVV_REASONCODE3DESC}} |
Reason Code 3 Comment | Reason Code 4 | Reason Code 4 Desc | Reason Code 4 Comment | Reason Code 5 | Reason Code 5 Desc | Reason Code 5 Comment | Reason Code 6 |
{{visitVerification.EVV_REASONCODE3COMMENT}} | {{visitVerification.EVV_REASONCODE4}} | {{visitVerification.EVV_REASONCODE4DESC}} | {{visitVerification.EVV_REASONCODE4COMMENT}} | {{visitVerification.EVV_REASONCODE5}} | {{visitVerification.EVV_REASONCODE5DESC}} | {{visitVerification.EVV_REASONCODE5COMMENT}} | {{visitVerification.EVV_REASONCODE6}} |
Reason Code 6 Desc | Reason Code 6 Comment | Reason Code 7 | Reason Code 7 Desc | Reason Code 7 Comment | Reason Code 8 | Reason Code 8 Desc | Reason Code 8 Comment |
{{visitVerification.EVV_REASONCODE6DESC}} | {{visitVerification.EVV_REASONCODE6COMMENT}} | {{visitVerification.EVV_REASONCODE7}} | {{visitVerification.EVV_REASONCODE7DESC}} | {{visitVerification.EVV_REASONCODE7COMMENT}} | {{visitVerification.EVV_REASONCODE8}} | {{visitVerification.EVV_REASONCODE8DESC}} | {{visitVerification.EVV_REASONCODE8COMMENT}} |
Reason Code 9 | Reason Code 9 Desc | Reason Code 9 Comment | Reason Code 10 | Reason Code 10 Desc | Reason Code 10 Comment | Overall Reason Code | {{}} |
{{visitVerification.EVV_REASONCODE9}} | {{visitVerification.EVV_REASONCODE9DESC}} | {{visitVerification.EVV_REASONCODE9COMMENT}} | {{visitVerification.EVV_REASONCODE10}} | {{visitVerification.EVV_REASONCODE10DESC}} | {{visitVerification.EVV_REASONCODE10COMMENT}} | {{visitVerification.EVV_OVERALLREASONCODE}} | {{}} |
Verification Information
SVC Code | HCPCS Code | Modifier | Visit Date | Created Date Time | Phone | Call In Time | Call Out Time | Actual Hours |
{{visitVerification.EVV_SVCCODE}} | {{visitVerification.EVV_HCPCS_CODE}} | {{visitVerification.EVV_MODIFIER}} | {{visitVerification.EVV_VISITDATE}} | {{visitVerification.EVV_CREATEDDATETIME}} | {{visitVerification.EVV_PHONE}} | {{visitVerification.EVV_CALLINTIME}} | {{visitVerification.EVV_CALLOUTTIME}} | {{visitVerification.EVV_ACTUALHOURS}} |
Pay Hours | Units | Visit Location | Visit Latitude In | Visit Longitude In | Learned Location | Lat Long Match In | Input Method In | Input Method Out |
{{visitVerification.EVV_PAYHOURS}} | {{visitVerification.EVV_UNITS}} | {{visitVerification.EVV_VISITLOCATION}} | {{visitVerification.EVV_VISIT_LATITUDE_IN}} | {{visitVerification.EVV_VISIT_LONGITUDE_IN}} | {{visitVerification.EVV_LEARNED_LOCATION}} | {{visitVerification.EVV_LAT_LONG_MATCH_IN}} | {{visitVerification.EVV_INPUTMETHOD_IN}} | {{visitVerification.EVV_INPUTMETHOD_OUT}} |
Alternative Device Id | Visit Notes | Last Visit Maint | Upload Indicator | Last Upload | Vendor Id | File Export Id | Do Not Export Indicator | Auto Confirm Flag |
{{visitVerification.EVV_ALTERNATIVEDEVICEID}} | {{visitVerification.EVV_VISITNOTES}} | {{visitVerification.EVV_LASTVISITMAINT}} | {{visitVerification.EVV_UPLOADINDICATOR}} | {{visitVerification.EVV_LASTUPLOAD}} | {{visitVerification.EVV_VENDORID}} | {{visitVerification.EVV_FILEEXPORTID}} | {{visitVerification.EVV_DONOTEXPORTINDICATOR}} | {{visitVerification.EVV_AUTOCONFIRMFLAG}} |
Visit Record Indicator | Visit Latitude Out | Visit Longitude Out | Material VM Change | Material VM Field Id | Lat Long Match Out | {{}} | {{}} | {{}} |
{{visitVerification.EVV_VISITRECORDINDICATOR}} | {{visitVerification.EVV_VISIT_LATITUDE_OUT}} | {{visitVerification.EVV_VISIT_LONGITUDE_OUT}} | {{visitVerification.EVV_MATERIAL_VM_CHANGE}} | {{visitVerification.EVV_MATERIAL_VM_FIELD_ID}} | {{visitVerification.EVV_LAT_LONG_MATCH_OUT}} | {{}} | {{}} | {{}} |
ID # | F. Name | L. Name | DOB | Role | Branch | Action |
---|---|---|---|---|---|---|
{{employee.TMHP_EMPLOYEE_EMPLOYEEID}} | {{employee.TMHP_EMPLOYEE_FIRSTNAME}} | {{employee.TMHP_EMPLOYEE_LASTNAME}} | {{employee.REV_SADOB | date}} | {{employee.TMHP_EMPLOYEE_EMPLOYEEDISCIPLINE}} | {{employee.TMHP_BRANCH}} | ✎ ✖ |
TIN | NPI | API | TPI | Legal Name | DBA Name | Contact Number | Address 1 |
Address 2 | City | State | ZIP | Location ID | Region | From Date | To Date |
Employee Information
Employee ID | VISA PASSPORT | Discipline | First Name | Last Name | EVV ID | Start Date |
End Date | EVV User ID | EVV User First Name | EVV User Last Name | CDS EMPLOYER EVVID | CDS EMPLOYER FIRST NAME | CDS EMPLOYER LAST NAME |
Member Information
Payer | First Name | Last Name | Member MEDICAID | DOB | EVV ID | Start | End | Priority |
Phone | Alt Phone | Alt Phone 2 | Address Latitude | Address Longitude | Total Authunits | Auth Units Type | Total Auth Units Reamaining | |
Visit Information
Visit ID | Schedule ID | Visit Date | Visit Time In | Visit Time Out | Visit Hours | Visit Location | SVCGRP |
Reason Code
Reason Code 1 | Reason Code 1 Desc | Reason Code 1 Comment | Reason Code 2 | Reason Code 2 Desc | Reason Code 2 Comment | Reason Code 3 | Reason Code 3 Desc |
Reason Code 3 Comment | Reason Code 4 | Reason Code 4 Desc | Reason Code 4 Comment | Reason Code 5 | Reason Code 5 Desc | Reason Code 5 Comment | Reason Code 6 |
Reason Code 6 Desc | Reason Code 6 Comment | Reason Code 7 | Reason Code 7 Desc | Reason Code 7 Comment | Reason Code 8 | Reason Code 8 Desc | Reason Code 8 Comment |
Reason Code 9 | Reason Code 9 Desc | Reason Code 9 Comment | Reason Code 10 | Reason Code 10 Desc | Reason Code 10 Comment | Overall Reason Code | |
Verification Information
SVC Code | HCPCS Code | Modifier | Visit Date | Created Date Time | Phone | Call In Time | Call Out Time | Actual Hours |
Pay Hours | Units | Visit Location | Visit Latitude In | Visit Longitude In | Learned Location | Lat Long Match In | Input Method In | Input Method Out |
Alternative Device Id | Visit Notes | Last Visit Maint | Upload Indicator | Last Upload | Vendor Id | File Export Id | Do Not Export Indicator | Auto Confirm Flag |
Visit Record Indicator | Visit Latitude Out | Visit Longitude Out | Material VM Change | Material VM Field Id | Lat Long Match Out | |||
ID | First Name | Last Name | Phone | ||||
SUN | MON | TUE | WED | THU | FRI | SAT | |
IN | |||||||
OUT | |||||||
IN | |||||||
OUT | |||||||
TOTAL |
Provider Information
Employee InformationMember InformationVisit InformationReason CodeVerification Information
TIN | NPI | API | TPI | Legal Name | DBA Name | Contact Number | Address 1 | |
Address 2 | City | State | ZIP | Location ID | Region | From Date | To Date | |
Employee ID | VISA PASSPORT | Discipline | First Name | Last Name | EVV ID | Start Date | ||
End Date | EVV User ID | EVV User First Name | EVV User Last Name | CDS EMPLOYER EVVID | CDS EMPLOYER FIRST NAME | CDS EMPLOYER LAST NAME | ||
Payer | First Name | Last Name | Member MEDICAID | DOB | EVV ID | Start | End | Priority |
Phone | Alt Phone | Alt Phone 2 | Address Latitude | Address Longitude | Total Authunits | Auth Units Type | Total Auth Units Reamaining | |
Visit ID | Schedule ID | Visit Date | Visit Time In | Visit Time Out | Visit Hours | Visit Location | SVCGRP | |
Reason Code 1 | Reason Code 1 Desc | Reason Code 1 Comment | Reason Code 2 | Reason Code 2 Desc | Reason Code 2 Comment | Reason Code 3 | Reason Code 3 Desc | |
Reason Code 3 Comment | Reason Code 4 | Reason Code 4 Desc | Reason Code 4 Comment | Reason Code 5 | Reason Code 5 Desc | Reason Code 5 Comment | Reason Code 6 | |
Reason Code 6 Desc | Reason Code 6 Comment | Reason Code 7 | Reason Code 7 Desc | Reason Code 7 Comment | Reason Code 8 | Reason Code 8 Desc | Reason Code 8 Comment | |
Reason Code 9 | Reason Code 9 Desc | Reason Code 9 Comment | Reason Code 10 | Reason Code 10 Desc | Reason Code 10 Comment | Overall Reason Code | ||
SVC Code | HCPCS Code | Modifier | Visit Date | Created Date Time | Phone | Call In Time | Call Out Time | Actual Hours |
Pay Hours | Units | Visit Location | Visit Latitude In | Visit Longitude In | Learned Location | Lat Long Match In | Input Method In | Input Method Out |
Alternative Device Id | Visit Notes | Last Visit Maint | Upload Indicator | Last Upload | Vendor Id | File Export Id | Do Not Export Indicator | Auto Confirm Flag |
Visit Record Indicator | Visit Latitude Out | Visit Longitude Out | Material VM Change | Material VM Field Id | Lat Long Match Out | |||