Community Care Access Centre (CCAC)
Billing Reconciliation Report Format Specification
Organization: / Ontario Association of Community Care Access Centres (OACCAC)Division: / Business Solutions
Version: / 2.10
Version Date: / October 23, 2009
Prepared By: / Ion Moraru
Updated By: / Ellen Hsu
Date: October 23, 2009 1
Community Care Access Centre (CCAC) / Version: 2.10Billing Reconciliation Report Specification / Version Date: October 23 2009
Revision Log
Version No. / Version Date / Summary of Change / Changed by/Input from /1.0 / October 19, 2007 / First draft / Guy Fortin
1.1 / October 22, 2007 / Updated valid value list in ServiceType description
Changed size of ClientReferralCode from 2 to 12 (typo / Guy Fortin
1.2 / November 13, 2007 / Change VendorCost $$ attributes mandatory
Add attribute LineItemStatusReasonCode to BillingLineItem and Appendix A to list valid codes / Guy Fortin
1.3 / December 4, 2007 / Change VendorContractCode and ProviderContractCode to ContractCode
Add VendorSuppliedLineItemNumber to BillingLineItem
Remove inappropriate values from LineItemStatus
Change from multiple Reason Codes (one per Item type) to a single Reason Code for all types in Appendix A
Add a Date and Time Description in chapter 2 / Guy Fortin
2.0 / January 25, 2008 / Renamed BillingRAReport element to BillingReconciliationReport
Added ReconciliationId to BillingReconciliationReport
Changed VendorInvoiceDate from Optional to Mandatory
Added GeographicalArea to BillingLineItem element
Added ClientFirstName to Client element
Moved VendorCost element from BillingLineItem element to EquipmentAndSupplyItem element
Moved ContractCode from EquipmentAndSupplyItem and PurchasedServiceItem element to BillingLineItem element
Change DeliveryDate and StartDate from Optional to Mandatory in EquipmentAndSupplyItem element
Added ServiceOrderId to PurchasedServiceItem element
Moved QuantityBilled from PurchasedServiceItem element to BillingLineItem element / Guy Fortin
2.1 / Feb 7, 2008 / Added BillingLineItems element to BillingReconciliationReport element
Added ContractName to BillingLineItem
Added ItemOrderType and RecordType attributes to EquipmentAndSupplyItem element
Made VendorCost, Type, and UnitDollarRate mandatory on E&SItem
Made ServiceOrderId mandatory on PurchasedServiceItem
Made ProviderActivityCode optional on PurchasedServiceItem
Updated Appendix B with diagrams instead of condensed XML / Guy Fortin
2.2 / Feb 7, 2008 / Added ServiceDeliveryType and LocalDistinction to PurchasedServiceItem Service element
Added ServiceDeliveryType Appendix / Guy Fortin
2.3 / Feb 19, 12008 / Added ReportType and LineItemCount to BillingReconciliationReport element
Made TotalVendorPayable element Optional
Moved all fields from the BillingLineItem element to the EquipmentAndSupplyItem and PurchasedServiceItem elements
Removed UnitDollarRate from EquipmentAndSupplyItem
Moved GeographicArea from PurchasedServiceItem to Service element / Guy Fortin
2.4 / Feb 19, 2008 / Added Type attribute to PurchasedServiceItem / Guy Fortin
2.5 / March 3, 2008 / Reflect Feedback from CHRIS Team review
- Make TotalVendorPayable mandatory
- Change PayableAmountWithTax to PayableAmountWithoutTax
- Deleted RecordType, and ItemOrderType attributes and GeograpicArea from EquipmentAndSupplyItem element
- Made OriginalItemDescription, DeliveryDate, StartDate optional in EquipementAndSupplyItem
- Change BillingAmountWithTax to BillingAmountWithoutTax in EquipementAndSupplyItem / Guy Fortin
2.6 / March 7, 2008 / Renamed ClientReferralCode to BillingReferenceNumber and moved it from Client sub-element to PurchasedServiceItem and EquipmentAndSupplyItem element / Guy Fortin
2.7 / May 27, 2008 / Renamed ServiceOrderID to ProviderAssignmentId in the PurchaseServiceItem element.
Added RecordType attribute to the EquipmentAndSuppliesItem element. / Ion Moraru
2.8 / June 18, 2008 / Added TransmissionDateTime to the main element
Added SpecialtyCode to the Service element
Removed ContractName from EquipmentSupplyLineItem and PurchaseServiceItem element
Changed the QuantityBilled’s type to decimal
Renamed to DeliveryDateTime and changed the type to datetime.
Added a new element RentalBillingPeriod and moved Start Date and End Date under it.
Removed R-2 reason code for Debit/Credit edit check. / Ion Moraru
2.9 / September 15, 2009 / Turned TotalVendorPayable into a simple (decimal) type instead of an complex type. / Ion Moraru
2.10 / Oct 21, 2009 / Change Mandatory fields to Optional:
ClientIdentifier, VendorInvoiceDate
DeliveryDateTime changed to DeliveryDate
Change DateTime to Date:
VendorInvoiceDate, LastProcessedDate, DeliveryDate, LastProcessedDate, RentalBillingStartDate, RentalBillingEndDate, VisitDate
BillingAmountWithoutTax changed to AmountBilled
Change Line Item Status Reason Code
Change Description in LineItemType and AmountBilled
OrganizationCode changed to OrganizationName / Ellen Hsu
Table of Contents
1. Billing Reconciliation Report 7
1.1 Brief Description 7
1.2 High Level Structure 7
2. Billing Reconciliation Report Elements 8
2.1 BillingReconciliationReport element detail 8
2.2 BillingLineItem element detail 10
2.3 EquipmentAndSupplyItem element detail 10
2.4 PurchasedServiceItem element detail 14
3. Appendix A - Line Item Status Reason Code 20
4. Appendix B - Service Delivery Type 21
1. Billing Reconciliation Report
1.1 Brief Description
When a Billing Invoice is processed by a CCAC, a Billing Reconciliation Report is sent back to the vendor or provider to communicate the status of each item billed. The Billing Invoice is described in the CCAC Billing Invoice Format Specification document.
This document specifies the information and associated format that make up a Billing Reconciliation Report.
1.2 High Level Structure
The Billing Reconciliation Report is an XML document with the following high level element structure:
As the diagram above depicts, a BillingReconciliationReport element may contain from one to several BillingLineItem elements. A BillingLineItem element can then in turn contain one of either an EquipmentAndSupplyItem or a PurchasedServiceItem element. These four elements represent the high level structure of the Billing Reconciliation Report.
2. Billing Reconciliation Report Elements
The following tables document the fields and elements that make up a Billing Reconciliation Report.
A note about Date and Time specification:
All dates and times contained in the specification adhere to the W3C Universal Time Code (UTC) standard and are formatted as follows:
· date: yyyy-mm-dd (size 10 bytes); e.g. 2007-11-21
· datetime: yyyy-mm-ddThh:mm[:ssTZD]; (size 16 bytes - if omitting ss and TZD - and 25 bytes with ss and TZD); e.g. 2007-11-21T14:56:19-05:00 (for EST timezone)
· time: hh:mm[:ssTZD] (size 5 - if omitting ss and TZD - and 14 bytes with ss and TZD); e.g. 14:56:19-05:00
Where "yyyy" represents the year, "mm" the month from 01 through 12, "dd" the day of the month, "T" separates the date from the time, "hh" the hour from 00 through 24, "mm" the minutes, "ss" the seconds and TZD represents the timezone which reflect the times difference relative to GMT, so it can range from +12:00 to -13:00; both "ss" and TZD are optional; TZD is not yet supported by this specification.
2.1 BillingReconciliationReport element detail
Name / Field Length (bytes) / Type / Mandatory? / Description / Flat FileVersion (Attribute of BillingReconciliationReport element) / Max 10 / Num / Yes / The version of the Schema that this BillingReconciliationReport document adheres to. E.g. "1.0". This is required for the receiving vendor / provider to correctly interpret the information being provided by the CCAC / N/A
ReportType / 25 / Alpha / No / One of "Purchased Service" or "Equipment and Supplies" / N/A
InvoiceFileNumber / 25 / Alpha / num / Yes / CCAC unique id for this report / N/A (for E&S)
ReconciliationID (for PS)
OrganizationName / 250 / Alpha / Yes / The Organization name based on the Organization Code assigned to Vendor by local CCAC. Reference may be “provider” or “vendor” organization
CcacCode / 2 - 4 / Alpha / Yes / A unique number for the CCAC. Valid values are: "ESC" |"SW" | "WW" | "HNHB" | "CW" | "MH" |"TC" | "CENT"| "CE"| "SE" | "CHAM"| "NSM"| "NE" | "NW" / CCACId
VendorInvoiceDate / 10 / Date / No / The vendor provided Date on the Billing Invoice / N/A
VendorInvoiceNumber / Max 50 / Alpha numeric / No / The vendor provided Invoice Number on the Billing Invoice / InvoiceFileNumber (for E&S)
N/A (for PS)
LineItemCount / 5 / Num / Yes / The number of line items included in the report / TotalLineItemCount (for E&S)
RecordCount (for PS)
TotalVendorPayable / 10 / Num / Yes / The total amount with taxes included / N/A (for E&S)
TotalPayable (for PS)
BillingLineItems (element) / Element / Yes / A list of 1 or more BillingLineItems
TransmissionDateTime / 10 / DateTime / Yes / The date and time this transmittal occurred. / N/A
2.2 BillingLineItem element detail
Name / Field Length (bytes) / Type / Mandatory? / DescriptionBillingLineItems (list) / element / Yes / List of either EquipmentAnsSupplyItem or PurchasedServiceItem elements
2.3 EquipmentAndSupplyItem element detail
Name / Field Length (bytes) / Type / Mandatory? / Description / Flat FileLineItemType (attribute of EquipmentAndSupplyItem) / Max 10 / Alpha / Yes / Identifies this Line Item as either a "Rental" | "Purchase"
Finance item will be identified as “Purchase” / LineItemType
Client (Element) / - / - / Yes / An Element that contains the following client information fields
ClientIdentifier / 12 / Alpha/
Num / No / A code that identifies the Client associated with this item. This number was provided by the CCAC at time of order / N/A
ClientLastName / 50 / Alpha / Yes / The last name of the Client associated with this item. This information was provided by the CCAC at time of order / Surname
ClientFirstName / 50 / Alpha / No / The first name of the Client associated with this item. This information was provided by the CCAC at time of order
BillingReferenceNumber / 12 / Alpha/Num / Yes / A code that identifies the Client Referral associated with this item. This number was provided by the CCAC at time of order / BillingReference#
ContractCode / Max 15 / Alpha/Num / Yes / Contract Number assigned to Vendor by the CCAC when the contract was entered into / VendorContractCode
VendorSuppliedLineNumber / Max 15 / Alpha / num / No / An optional value supplied by the vendor in the Invoice that is returned back to the vendor by the CCAC in the Reconciliation Report / Vendor Reference
PurchaseOrderNumber / Max 15 / Alpha/num / Yes / The Purchase Order number provided by the CCAC at time of order / PO Number
PurchaseOrderLineNumber / Max 15 / Alpha/num / Yes / The code that identifies this Line Number to the CCAC; provided by the CCAC at time of order / PO Line Item#
VendorItemCode / Max 15 / Alpha/num / Yes / The code that identifies the specific item ordered and delivered to the client; Assigned by CCAC / VendorItemCode
LineItemUnitCode / Max 10 / Alpha / Yes / Code for the units in which the item has been delivered (e.g., UNIT,EACH, CASE, BOX, SET, DOZ, GROSS) / ItemUnitCode
QuantityBilled / Max 8 / Num / Yes / The number of Units being billed for by this item (decimal 6.2). / Quantity
DeliveryDate / 10 / Date / No / Date Equipment was delivered. Mandatory for Purchased Items. / StartDate
ReconciliationOutcome / Element / Yes / The result of the line item billing reconciliation.
LineItemStatus / 15 / Alpha / Yes / The CCAC determined status for this line item. Possible values include:
Payable Rejected Suspended / ProcessingStatus
LineItemStatusReasonCode / Max 15 / Alpha / No / Identifies the reason for the line item to be Suspended or Rejected. See Appendix A for a listing of valid codes / ReasonCode
LastProcessedDate / 10 / Date / Yes / The date when the CCAC last Processed this item / ProcessingDate
RentalBilllingPeriod / element / No
RentalBillingStartDate / Max 10 / Date / Yes / The Rental start date from the invoice / StartDate
RentalBillingEndDate / Max 10 / Date / Yes / The Rental end date from the invoice / EndDate
VendorCost (element) / - / element / Yes / An Element that contains the following cost information
Type(attribute) / 6 / Alpha / Yes / Attribute of the VendorCost Element with value DEBIT or CREDIT to identify this line time as either a DEBIT or a CREDIT to the CCAC. DEBIT is the default. / N/A
AmountBilled / 8 / Num / Yes / Amount being billed for this item / AmountPayable
GST / 5 / Num / Yes / Amount of Goods & Services Tax for this item / GST
PST / 5 / Num / Yes / Amount of Provincial Sales Tax for this item / PST
2.4 PurchasedServiceItem element detail
Name / Field Length (bytes) / Type / Mandatory? / Description / Flat FileType (attribute) / 15 / Alpha / No / One of "Debit" or "Credit" (default to “Debit”) / N/A
Client (Element) / - / - / Yes / An Element that contains the following client information fields
ClientIdentifier / 12 / Alpha/
Num / No / A code that identifies the Client associated with this item. This number was provided by the CCAC at time of order / N/A
ClientLastName / 50 / Alpha / Yes / The last name of the Client associated with this item. This information was provided by the CCAC at time of order / Surname
ClientFirstName / 50 / Alpha / No / The first name of the Client associated with this item. This information was provided by the CCAC at time of order / N/A
ProviderAssignmentId / 25 / Alpha / num / No / The unique number that identified this item when it was first ordered / N/A
BillingReferenceNumber / 12 / Num / Yes / A code that identifies the Client Referral associated with this item. This number was provided by the CCAC at time of order / BillingReferenceNumber
ContractCode / Max 15 / Num / No / Contract Number assigned to Vendor by the CCAC when the contract was entered into / N/A
VendorSuppliedLineNumber / Max 15 / Alpha / num / No / An optional value supplied by the vendor in the Invoice that is returned back to the vendor by the CCAC in the Reconciliation Report / N/A
QuantityBilled / Max 8 / Num / Yes / The number of Units being billed for by this item. / Quantity
ProviderBillingCode / 4 / Num / Yes / A billing code assigned to the provider contract which represents a rate and a period of time / BillingCode
Service (element) / - / element / Yes / An Element that contains the following three fields to describe the Service that is being billed for in this item
ServiceType / Max 30 / Alpha / Yes / Assigned by CCAC. Identifies the general service delivered to the client; valid values are:
AMB Ambulance Services - CCAC
AT Attendant Care - CCAC
DP Adult Day Program - CCAC
ENT Enterostomal Therapy
ER Children's Enhanced Respite Service
GER Psychogeriatric Resource Coord - CCAC
HOM Home Support (Homemaking)
LAB Laboratory Services - CCAC
MOW Meals on Wheels - CCAC
NP Nurse Practitioner
NUR Nursing
NUT Nutritional Services
ODB Ontario Drug Benefit
OT Occupational Therapy
PAS Pastoral Care
PHA Pharmacy Consultation
PHY Physician
PM Paramedical Services - CCAC
PSM Palliative Pain & Sympton Mgmt
PSY Psychology
PT Physiotherapy
RT Respiratory Therapy
SH Supportive Housing - CCAC
SP Speech/Language Pathology
SW Social Work
TRANS Transportation - CCAC / ServiceCode
ServiceDeliveryType / Max 50 / Alpha / Yes / Identifies a more specific service within the general ServiceType to be delivered to the client; See Appendix B for list of valid values / N/A
UnitOfService / Max 6 / Alpha / Yes / Code assigned by CCAC for the units in which the service has been delivered (e.g., HOUR, VISIT) / ServiceUnitCode
SpecialtyCode / Max 20 / Alpha / No / Specialty designation required for this service. Please refer to Appendix B for Service specialties associated with Service Delivery Types. / N/A
GeographicArea / 250 / Alpha / num / No / CCACs can further define contracts specific to a geographic area, or a local contract distinction. / N/A
LocalDistinction / 250 / Alpha / num / No / In addition to geographic areas, contracts can be further defined by other locally defined distinctions.
The local distinction will be used by CCACs who have separate contracts for specific client groups, such as Children / Adults / ABI distinctions for OT. / N/A
ProviderActivityCodes (list) / Max 50 / Alpha / No / A list of Activity Code elements that Identifies the service provider activity with the client. / ServiceActivities
VisitDate / 10 / Date / Yes / The date when the service was delivered / VisitDate
ReconciliationOutcome / Element / Yes / The result of the line item billing reconciliation.
LineItemStatus / 15 / Alpha / Yes / The CCAC determined status for this line item. Possible values include: Payable | Rejected | Suspended / ProcessingStatus
LineItemStatusReasonCode / Max 15 / Alpha / No / Identifies the reason for the line item to be Suspended or Rejected. See Appendix A for a listing of valid codes / ReasonCode
LastProcessedDate / 10 / Date / Yes / The date when the CCAC last Processed this item / DateProcessed
3. Appendix A - Line Item Status Reason Code