6 decimal No Number of hours per visit. The submitted frequency period cancel 10 Alpha Yes reason code in the original provider report. 100 Alpha Yes The name of the submitted frequency period cancel reason code in the original provider report. Additional provider comments pertaining to 250 Alpha / Num No visit cancellation Frequency element See Yes The full details of the requested frequency. Frequency element detail 50 Alpha Yes Name of the change request status, representing Approved or Denied 10 Alpha Yes Code of the change request status, representing Approved or Denied 50 Alpha Yes Description of the change request type ChangedFrequency element No Representing the submitted “Change Frequency” request in the original provider report EndDate 10 Date Yes The requested frequency end date in the original request
6 decimal No Number of hours per visit. 10 Alpha Yes The submitted frequency period cancel reason code in the original provider report. 100 Alpha Yes The name of the submitted frequency period cancel reason code in the original provider report. 250 Alpha / Num No Additional provider comments pertaining to visit cancellation Frequency element See Frequency element detail Yes The full details of the requested frequency. 50 Alpha Yes Name of the change request status, representing Approved or Denied 10 Alpha Yes Code of the change request status, representing Approved or Denied 50 Alpha Yes Description of the change request type ChangedFrequency element No Representing the submitted “Change Frequency” request in the original provider report EndDate 10 Date Yes The requested frequency end date in the original request
CCAC%20Service%20Referral%20Format%20-%20Specifications%20v2.21.docx