Community Care Access Centre (CCAC)
Billing Invoice Format Specification
Organization: / Ontario Association of Community Care Access Centres (OACCAC)Division: / Business Solutions
Version: / 2.11
Version Date: / December 09,2009
Prepared By: / Ion Moraru
Updated By: / Ellen Hsu
Date: December 9, 20091
Community Care Access Centre (CCAC) / Version: 2.11Billing Invoice Format Specification / Version Date: December 09, 2009
Revision Log
Version No. / Version Date / Summary of Change / Changed by/Input from1.0 / October 19, 2007 / First draft / Guy Fortin
1.1 / October 26, 2007 / Changed size of ClientReferralCode from 2 to 12 (typo)
Added Activity Code table in Appendix A
Renamed Distilled XML Chapter to Appendix B
ClientLastName and LineItemUnitCode changed from mandatory to optional
Other minor edits to descriptions / Guy Fortin
1.2 / November 13, 2007 / Fixed typo in Figure 1 (changed "0 to several" to "1 to several") / Guy Fortin
1.3 / December 4, 2007 / Change VendorContractCode and ProviderContractCode to ContractCode
Add VendorSuppliedLineItemNumber to BillingLineItem
Add UnitOfService to PurchasedServiceItem
Added a Date and Time description in section 2 / Guy Fortin
2.0 / January 25, 2008 / Added ClientFirstName to BillingLineItem 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 8, 2008 / Added ContractName to BillingLineItem element
Changed ClientLastName to Mandatory in Client element
Added GeographicArea to to BillingLineItem element
Adde ItemOrderType and RecordType attributes to E&SSupplyItem element
Chamged LineItemUnitCode, BillingAmountWithTax, GST, and PST to Mandatory on E&SsupplyItem element
Added UnitDollarRate for VendorCost element
Added Service element to PurchasedServiceItem element (and move UnitOfService there)
Added ServiceDeliveryType appendix
Updated Distilled XML appendix with diagrams / Guy Fortin
2.2 / Feb 8, 2008 / Changed version number so that its in sync with the XML schema file / Guy Fortin
2.3 / Feb 19, 2008 / Added InvoiceType field to BillingInvoice element
Added OriginatingFilename to BillingInvoice element
Moved all fields from BillingLineItem element to EquipmentAndSupply element or PurchasedServiceItem element and deleted BillingLineItem
Removed ProviderActivityCodes from PurchasedServiceItem (already present in Service element)
Moved GeopgraphicArea from PurchasedServiceItem element to Service element / Guy Fortin
2.4 / Feb 19, 2008 / Added Type attribute to PurchasedServiceItem element / Guy Fortin
2.5 / March 3, 2008 / Reflect feedback from CHRIS Team review
-Make InvoiceType mandatory
-Deleted RecordType and ItemOrderType attributes, and GeographicalArea from EquipementAndSupplyItem element
-Made OriginalItemDescription, DeliveryDate, StartDate optional in EquipementAndSupplyItem
-Change BillingAmountWithTax to BillingAmountWithoutTax in EquipementAndSupplyItem
-Make ServiceOrderId mandatory in PurchasedServiceItem / Guy Fortin
2.6 / March 7, 2008 / Renamed ClientReferralCode to BillingReferenceNumber and moved it from Client element to PurchasedService element / Guy Fortin
2.7 / April 21, 2008 / Neglected to actually rename ClientReferralCode to BillingReferenceNumber in PurchasedService element
2.8 / May 27, 2008 / Renamed ServiceOrderID to ProviderAssignmentId in the PurchaseServiceItem element.
Added RecordType attribute to the EquipmentAndSuppliesItem element. / Ion Moraru
2.9 / June 17, 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 RentalPeriod and moved Start Date and End Date under it. / Ion Moraru
2.10 / October 29, 2009 / Value of <ReBill> changed from Alpha “Yes” “No” to Boolean “1” or “0”. / Ellen Hsu
2.11 / December 9, 2009 / Added Sender and Destination elements that describer the participants in the message exchange
Changed the ServiceType to ServiceCode / Arthur Bydon
Table of Contents
1.Billing Invoice
1.1Brief Description
1.2High Level Structure
2.Billing Invoice Elements
2.1BillingInvoice element detail
2.2EquipmentAndSupplyItem element detail
2.3PurchasedServiceItem element detail
3.Appendix A - Activity Codes
4.Appendix B - Service Delivery Type
5.Appendix B - Distilled XML Schema for Billing Invoice
Billing Invoice- Brief Description
A Billing Invoice isa document that issent by a provideror vendor to a CCAC as a means of billingfor purchased services, rentals, or purchased items.Once a Billing Invoice has been received and processed by a CCAC, a Billing ReconciliationReport is sent back to the vendor or provider to communicate the status of each billed line item.
This document specifies the information and associated format that make up a Billing Invoice, the Reconciliationreport is described in a separate document called"CCAC Billing ReconciliationReport Format Specification".
.
1.2High Level Structure
The Billing Invoice is an XML document with the following high level element structure:
Figure 1 Billing Invoice Structure
As the diagram above depicts, aBillingInvoiceelement may contain from zero to several BillingLineItemelements. A BillingLineItem element can be one of either an EquipmentAndSupplyItem or aPurchasedServiceItem element. These four elements represent the high level structure of the Billing Invoice document.Note that there is currently a restriction on a Billing Invoice in that it can only contain one type of Item. That is, an invoice must contain either EquipmentAndSupplyItems or PurchasedServiceItems but not both.
- Billing Invoice Elements
The following tablesdocument the fields and elements that make up a Billing Invoice.
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.
2.1BillingInvoice elementdetail
Name / Field Length (bytes) / Type / Mandatory? / Description / Flat FileVersion (Attribute of BillingInvoice element) / Max 10 / Num / Yes / The version of the Schema that this BillingInvoice document adheres to. E.g. "1.0". This is required for the receiving CCAC system to correctly understand the information being provided
Sender (parent element) / - / - / Yes / A group of elements and attributes identifying the sender of the document.
Destination (parent element) / - / - / Yes / A group of elements and attributes identifying the recipient of the document
Organization (child element of Sender or Destination) / - / - / Yes / Identifies the organizationsending or receiving the document
Code (attribute of Organization) / 50 / Alpha/Num / Yes / Specifies the unique code of the sender or the recipient organization
Type (attribute of Organization) / 150 / Alpha/Num / Yes / Specifies the type of the sender organization. Valid content is:
“CCAC”“Provider” “Vendor”
Name (child of Organization) / 250 / Alpha / No / The name of the sender or the recipient organization
OwnerOrganization (child of Organization) / - / - / Yes / Specifies the owner organization of the sender or the recipient
Code (attribute of OwnerOrganization) / 50 / Alpha/Num / Yes / Specifies the unique code of the sender or the recipient owner organization
Type (attribute of OwnerOrganization) / 150 / Alpha/Num / No / Specifies the type of the sender or the recipient owner organization. Valid content is “CCAC”, “Provider” or “Vendor”. If not provided the “CCAC” type is assumed.
Name (child element of OwnerOrganization) / 250 / Alpha / No / The name of the sender or the recipient owner organization
OrganizationCode / 10 / Alpha/Num / Yes / A unique number assigned to Vendor by local CCAC. Reference may be “provider” or “vendor” organization / Header.VendorOrgCode
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
InvoiceType / 25 / Alpha / Yes / The type of invoice this represents. One of "Purchased Service" or "Equipment and Supplies" / N/A
VendorInvoiceDate / 10 / Date (yyyy-mm-dd) / No / A vendor provided Date for the Invoice / Header.InvoiceDate
VendorInvoiceNumber / Max 50 / Alpha numeric / No / A vendor provided Invoice Number / Header.VendorInvoice
Reference#
OriginatingFilename / 100 / Alpha numeric / No / The filename of the original invoice / N/A
TransmissionDateTime / 20 / DateTime / Yes / The date and time of this transmittal / N/A
LineItemCount / 10 / Numeric / Yes / Number of line items in this file / Header.RecordCount
2.2EquipmentAndSupplyItem element detail
Name / Field Length (bytes) / Type / Mandatory? / Description / Flat FileLineItemType(attribute of EquipmentAndSupplyItem) / Max10 / Alpha / Yes / Identifies this Line Item as either a "Rental" | "Purchase" | "Finance" item / SAFTYPE
Client (Element) / - / element / Yes / An Element that contains the following client information fields
ClientIdentifier / 12 / Alpha/
Num / Yes / 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
PurchaseOrderNumber / Max 15 / Alpha/num / Yes / The Purchase Order number provided by the CCAC at time of order / PurchaseOrder#
PurchaseOrderLineNumber / Max 15 / Alpha/num / Yes / Identifies this Line Item to the CCAC; provided by the CCAC at time of order / Equipment/Supply Line Item #
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 / Billing Reference #
ContractCode / Max 15 / Alpha/Num / Yes / Contract Number assigned to provider by the CCAC when the contract was entered into / VendorContractCode
VendorSuppliedLineItemNumber / Max 15 / Alpha / num / No / An optional value supplied by the vendor that is returned back to the vendor by the CCAC in the Reconciliation Report / VendorReference
RentalBilllingPeriod / element / No / Mandatory for Rental items / The last name of the Client associated
RentalBillingStartDate / Max 10 / Date / Yes / The date the rental period starts for this invoice / StartDate
RentalBillingEndDate / Max 10 / Date / Yes / The date the rental period ends. / EndDate
QuantityBilled / Max 8 / Num / Yes / The number of Units being billed for by this item (could be decimal 6.2). / Quantity
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
OriginalItemDescription / Max 50 / Alpha / No / This is the summary description of this line item as filled in by the CCAC at time of order / Equip/Supply Description
DeliveryDateTime / 20 / DateTime / No / Date the purchase item was delivered. Mandatory for Purchased+Finance Items. / StartDate (for Purchase Items)
VendorCost (element) / - / element / No / An Element that contains the following cost information
Type (Attribute) / 5 / 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; if not provided the default will be DEBIT / N/A
BillingAmountWithoutTax / 8 / Num / Yes / Amount being billed for this item without Goods & Services Tax (GST) or Provincial Sales Tax (PST) (decimal value) / LineItemCost
GST / 8 / Num / No / Amount of Goods & Services Tax for this item (decimal value) / GST
PST / 8 / Num / No / Amount of Provincial Sales Tax for this item (decimal value) / PST
Rebill / 6 / Boolean / No / Identifies that this item is being re-billed; valid values are "1" for yes | "0” for no. The default is “0”. / Rebill
2.3PurchasedServiceItem element detail
Name / Field Length (bytes) / Type / Mandatory? / Description / Flat FileType (attribute) / 6 / Alpha / Yes / "Credit" or "Debit"; if not provided the default will be DEBIT / N/A
Client (Element) / - / element / Yes / An Element that contains the following client information fields
ClientIdentifier / 12 / Alpha/
Num / Yes / 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 / Yes / The unique number that identified this item when it was first ordered / N/A
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 / HomeCareReference
ContractCode / Max 15 / Alpha/Num / Yes / Contract Number assigned to provider by the CCAC when the contract was entered into / N/A
VendorSuppliedLineItemNumber / Max 15 / Alpha / num / No / An optional value supplied by the vendor that is returned back to the vendor by the CCAC in the Reconciliation Report / VendorReference#
QuantityBilled / Max 8 / Num / Yes / The number of Units billed for this item. Decimal value 6.2 / Quantity
ProviderBillingCode / 4 / Num / Yes / A billing code assigned to the provider contract which represents a rate and a period of time / VendorIdentifier (line item level)
Service (element) / - / element / Yes / An Element that contains the following three fields to describe the Service that is being billed for in this item
ServiceCode / - / NUM / Yes / Assigned by CCAC. Identifies the general service delivered to the client; valid values are:
20AMB (Ambulance Services – CCAC)
27AT (Attendant Care – CCAC)
37DP (Adult Day Program – CCAC)
07ENT (Enterostomal Therapy)
21GER (Psychogeriatric Resource Coord – CCAC)
11HOM (Home Support (Homemaking))
09LAB (Laboratory Services – CCAC)
08MOW (Meals on Wheels – CCAC)
22NP (Nurse Practitioner)
01NUR (Nursing)
03NUT (Nutritional Services)
06OT (Occupational Therapy)
/ ServiceCode
29PAS (Pastoral Care)
30PHA (Pharmacy Consultation)
26PHY (Physician)
12PM (Paramedical Services – CCAC)
23PSM (Palliative Pain & Sympton Mgmt)
25PSY (Psychology)
05PT (Physiotherapy)
10RT (Respiratory Therapy)
04SP (Speech/Language Pathology)
02SW (Social Work)
24 TRANS (Transportation - CCAC)
ER (Children's Enhanced Respite Service)
ODB (Ontario Drug Benefit)
SH (Supportive Housing – CCAC)
ServiceDeliveryType / Max 50 / Alpha / Yes / Identifies amore 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 / No / 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 ActivitieCode elements that Identifies the service provider activity with the client. / ServiceActivities
VisitDate / 10 / Date / Yes / The date when the service was carried out / ServiceDateFrom
- Appendix A - Activity Codes
Service Type Code / Description / Activity Code and Description
<all> / Activities Common to All Services / 01 Assessment E.g. physical, functional, financial, psychosocial, environment, initial and ongoing and/or follow-up.
02 Conference on Behalf of Patient Conferences organized on behalf of the patient under the auspices of the Home Care Program.
03 Teaching/Counseling I.e. advising, instructing, supporting, interpreting, demonstrating, planning and problem solving: to include patient and/or significant other.
04 Equipment/Devices/Materials I.e. selection, design and training in the use of.
05 Situational Management Dealing with unexpected changes in the family situation.
09 Not Seen/Not Found Self-explanatory.
NUR, ENT / Nursing and Enterostomal Therapy / 10 Assistance with Personal Care (e.g. foot care, hair care, bath mouth care)
11 Dressing Care of wound.
12 Injection Introduction of medication subcutaneously or intramuscularly.
13 Vital Signs, Signs of life as related to a specific illness (i.e. temperature, pulse (apex and radial), respiratory, blood pressure, weight).
19 Other Treatment (e.g. IV therapy, enemata, ostomy care, cataract care, collection of blood, monitoring medications).
SW / Social Work / 20 Individual Therapy/Counseling Therapy and advice in a one to one relationship. Problems may have an emotional basis or be concrete ones of daily living.
21 Family and Marital Therapy When the family unit or marital relationship is the therapy focus.
22 Group Therapy When two or more persons interact in problem solving, e.g. coping with cancer.
23 Community Planning, developing, implementing, evaluating activities in support of Home Care Program Objectives, e.g. liaison with social agencies, inservice education.
SP / Speech Therapy / 40 Language Therapy Comprehension and expression of the symbols of human communication.
41 Articulation Therapy Intelligibility of speech and sound production.
42 Voice Therapy Loudness, pitch, clarity and sound production.
43 Rate Therapy Rate and/or rhythm of utterance.
44 Hearing Therapy Listening skills, lip reading.
PT / Physiotherapy / 50 Exercise Specific routines or techniques to increase or maintain strength, mobility, balances, coordination and chest care.
51 SupplementaryTesting Methods used to ascertain functional level including tolerance testing.
52 Monitor Physical Functional Capability Self-explanatory.
53 Modality Use of mechanical and/or physical agents.
OT / Occupational Therapy / 60 Functional Restoration Personal care, dressing, eating, postural exercise, diet, medications, toilet, sex, locomotion, transfers, transportation.
61 Household Management Organization and management of household, meals, money, marketing, laundry, etc.
62, 63 Energy Conservation/Work Techniques Simplification Self-explanatory
64 Psycho/Social Adjustments Interpersonal relationships/socialization. Family dynamics (child management, etc).
69 Vocational/Avocational Work readiness, play techniques, use of leisure.
HOM / Homemaking / 90 Housekeeping E.g. light housekeeping, laundry
91 Child Care Self-explanatory
92 Personal Care Under direction of the nurse or therapist, provides supervision of: bath, dressing, transfers, feeding medications, walking and communication
93 Meal Preparation/Special Diets E.g. diet supervision, advanced preparation of meals
94 Shopping Self-explanatory
99 Other E.g. outings, banking, accompanying patient to appointments.
PM / Paramedical / 80 Personal Care
89 Other
- Appendix B - Service Delivery Type
The following table provides the Service Delivery Type Code, as well as Specialty, Unit of Delivery, and Service Location, by Service Type Code