Core terms
| Term | Meaning |
|---|---|
| Agency | Your organization. The regulatory term used in licensing and CMS documentation. |
| Member | A person receiving care from your agency. Preferred over patient, client, or customer. |
| Service provider | An employee, contractor, or volunteer delivering care. Covers all credentialed care personnel. |
| Care plan | An individualized clinical plan of care, aligned with CMS terminology for home health. |
| Authorization | A payer’s approval to deliver a set number of service units over a date range. |
| Service item | A billable service your agency is approved to deliver. |
| EVV | Electronic Visit Verification. Federally required for Medicaid personal care services. |
| PHI | Protected Health Information. The HIPAA-defined category of regulated health data. |
| Orientation | Structured onboarding for a member or a new hire. Distinct from ongoing training. |
| Deficiency | A finding cited by a surveyor that your agency must correct. |
| QAPI | Quality Assurance and Performance Improvement. |
| CDS | Consumer Directed Services, where the member acts as employer of record. |
| PAS | Personal Assistance Services. |
| 837P | The electronic professional claim format submitted to payers. |
| Remittance advice | A payer’s explanation of what it paid, adjusted, or denied. |
| CARC / RARC | Claim Adjustment and Remittance Advice Reason Codes explaining payment decisions. |
Organization structure
| Term | Meaning |
|---|---|
| Organization | Your agency as a whole. All records belong to exactly one organization. |
| Location | A branch or office within your organization. |
| Active organization | The organization you are currently working in. Changing it changes every list you see. |
| Active location | The location filtering your location-scoped records. |
Status values
Member status
Members move through a long lifecycle. The most common values:| Status | Meaning |
|---|---|
PENDING_REFERRAL | A referral has arrived but has not been worked. |
NEW_INTAKE | Intake has started gathering information. |
PENDING_ASSESSMENT | Awaiting clinical assessment. |
PENDING_AUTHORIZATION | Awaiting payer approval before services can start. |
PENDING_ADMISSION_PACK | Awaiting completion of admission paperwork. |
NEW_ADMISSION | Recently admitted to service. |
ACTIVE | Currently receiving services. |
ON_HOLD | Services temporarily paused. |
HOSPITALIZED | In hospital; services suspended. |
RESUMED_SERVICES | Services restarted after a pause. |
RECERTIFICATION | Due for or undergoing recertification. |
UNITS_UPDATED | Authorized units changed. |
AUTHORIZATION_HAS_EXPIRY_DATE | Authorization is approaching its end date. |
SUSPENDED_AUTHORIZATION | Authorization suspended by the payer. |
SUSPENDED_ELIGIBILITY | Member’s payer eligibility lapsed. |
READMISSION | Returning to service after discharge. |
TRANSFERRED | Moved to another agency or location. |
DISCHARGED | Services ended. |
VOLUNTARY_DISCHARGE | Member chose to end services. |
TERMINATED | Services terminated by the agency or payer. |
TERMINATED_DECEASED | Services ended due to death. |
NON_ADMIT | Referral reviewed but not admitted. |
DISREGARDED_REFERRAL | Referral closed without action. |
OTHER | Anything not covered above. |
Visit and EVV status
| EVV status | Meaning |
|---|---|
SCHEDULED | Visit is planned but has not started. |
IN_PROGRESS | Attendant has clocked in. |
COMPLETED | Visit finished and verified. |
MISSED | Scheduled visit did not happen. |
EXCEPTION | Visit needs correction before it can be billed. |
Only
COMPLETED visits without an outstanding exception can flow into billing. See
EVV to paid claim.Billing status
| Status | Meaning |
|---|---|
NOT_BILLED | Not yet included on a claim. |
READY_FOR_BILLING | Verified and eligible to bill. |
BILLED | Submitted to the payer. |
PAID | Payment posted from a remittance. |
DENIED | Payer refused payment. |
Care plan status
| Status | Meaning |
|---|---|
DRAFT | Being prepared; not yet in effect. |
ACTIVE | In effect and guiding care. |
COMPLETED | Ran to its end date. |
DISCONTINUED | Stopped before completion. |
Licensing and survey status
| Status | Meaning |
|---|---|
License: ACTIVE, PENDING, EXPIRED, REVOKED | Current standing of a license or certification. |
Survey outcome: NO_DEFICIENCIES, DEFICIENCIES_CITED, IMMEDIATE_JEOPARDY | Result of a regulatory survey. |
Severity: STANDARD, CONDITION, IMMEDIATE_JEOPARDY | How serious a finding is. |
Correction: NOT_STARTED, IN_PROGRESS, COMPLETED, VERIFIED | Progress on a plan of correction. |
IMMEDIATE_JEOPARDY is the most serious classification available for both survey outcomes and
severity. Findings at this level carry regulatory deadlines. Escalate to your compliance officer
immediately.Incident status
| Status | Meaning |
|---|---|
OPEN | Reported, not yet investigated. |
UNDER_INVESTIGATION | Being reviewed. |
CLOSED | Investigation complete. |
Subscription tiers
| Tier | Size |
|---|---|
| Basic | 1–10 employees |
| Professional | 11–50 employees |
| Enterprise | 51+ employees or multiple locations |