Sometimes when I check a patient's eligibility on EVS using their recipient ID number, the coverage shows as not effective. Do not assume that a participant is eligible for Medical Assistance because he/she has an ACCESS or CHC health plan ID card. The EBT card is issued to MA recipients who receive cash assistance and/or food stamps as well as medical services, if eligible. Proudly founded in 1681 as a place of tolerance and freedom. A replacement card should be received in a maximum of seven days. If, however, you, use the recipient's social security number and date of birth, you may receive an eligible response because both of these. The Eligibility Verification System (EVS) has been enhanced to inform providers when a recipient has exceeded the 18 visit limit. h�b```a``������0�A���2�@�������aT\��'��)F���p V ��3���(���2�=���� � If a card is needed immediately, an interim paper card can be issued by the CAO. If I check the same patient's eligibility using their name and date of birth, coverage shows as effective. Prior to performing services, you should review the MA Bulletins related to SelectPlan. However, you should not assume that a patient is eligible whether they are able to present a valid identification card or not. caseworker to request a replacement card. 102 0 obj <>/Filter/FlateDecode/ID[<46AB8D3C391F27418DD69ED7F542B31C><34C31C85A0C9324FA6B9C9FEFD3A72C5>]/Index[79 69]/Info 78 0 R/Length 115/Prev 372090/Root 80 0 R/Size 148/Type/XRef/W[1 3 1]>>stream information returned from EVS is consistent across all methods of submission; however, depending upon the information submitted on the inquiry, the results may be different. Please enable scripts and reload this page. For additional information, please refer to Medical Assistance Bulletin 99-07-10 or the 18-visit limit procedure code chart which can be found on the department's website at 18 Visit Limit Chart, 8. 5. If those methods are not available, they can access the EVS through the Automated Voice Response System by calling 1-800-766-5387 and entering the recipient's social security number and date of birth. This program provides coverage of selected family planning services, pharmaceuticals, and. For example, if you perform an inquiry using the 10-digit recipient ID number and the two-digit card issue number, and either one of those data elements is incorrect (most likely the card issue number, as you must use the most current card issue number), you will receive an ineligible response. All Medical Assistance (MA) providers should check the PROMIS. Again, it is often easier for us to research your specific problem if you write us. In addition, the newly redesigned EBT card has entered into circulation. This is pursuant to the 18 visit limit, during the July 1 through June 30 state fiscal year service period. EVS will return the response "The ACCESS card is invalid". 6. A replacement card should be received in a maximum of seven days. EVS will accept and return the standardized electronic transaction formats for eligibility requests and responses as mandated by the Health Insurance Portability and Accountability Act (HIPAA). The Medicaid program of Pennsylvania follows certain requirements that enrollees must meet. How can I determine if a recipient is eligible for Medical Assistance (MA)/Medicaid if they do not have their ACCESS Card?All eligible recipients (including those recipients enrolled in a managed care organization [MCO]) will have a permanent identification card that identifies their eligibility for covered MA services. Providers and other approved agencies that submit electronic requests in the 270 format will receive an EVS response with eligibility information in the 271 format. endstream endobj startxref The interim card contains the same Recipient Number and Card Issue Number as the previous ACCESS card. The eligibility response format is called the HIPAA 271 Health Care Eligibility Benefit Response (also known as 271 Eligibility Response). If the old card is found or returned after a new card is obtained, the old card should be destroyed by the recipient, as it is no longer usable. Prior to performing services, you should review the MA Bulletins related to SelectPlan. e ™ Eligibility Verification System (EVS) before billing a MA beneficiary. However, you should not assume that a patient is eligible whether they are able to present a valid identification card or not. Welcome to the Pennsylvania Licensing System (PALS) PALS can help you apply for, renew, and check your professional license. The number to call is. Both formats may also be referenced by the 3-digit transaction number, 270 and 271. The purpose of EVS is to provide the most current information available regarding a recipient's MA eligibility and scope of coverage. How can I determine if the recipient has exceeded 18 office visits for the fiscal year?The Eligibility Verification System (EVS) has been enhanced to inform providers when a recipient has exceeded the 18 visit limit. Why does this happen?The information returned from EVS is consistent across all methods of submission; however, depending upon the information submitted on the inquiry, the results may be different. All eligible recipients (including those recipients enrolled in a managed care organization [MCO]) will have a permanent identification card that identifies their eligibility for covered MA services. EVS should be accessed on the date the service is provided since the recipient's eligibility is subject to change. Please enable scripts and reload this page. How many types of Medical Assistance cards are there and what is the difference between them?There are several types of Pennsylvania ACCESS cards providers may encounter. What happens if a recipient loses his/her ID card?When a Pennsylvania ACCESS card is lost or stolen, the recipient should contact his/her County Assistance Office (CAO) caseworker to request a replacement card. In the event that a recipient is eligible for health. It is important to verify and submit accurate recipient information when checking eligibility via the EVS. It is vital that you use EVS to verify eligibility each time you provide a service. The dial-up (modem) Bulletin Board System (BBS) solution for electronic file management was decommissioned at the end. It is important to verify and submit accurate recipient information when checking eligibility via the EVS. Batch EVS capabilities have been built into the, Providers have the option to submit individual EVS requests by telephone. For example, if you perform an inquiry using the 10-digit recipient ID number and the two-digit card issue number, and either one of those data elements is incorrect (most likely the card issue number, as you must use the most current card issue number), you will receive an ineligible response. It is vital that you verify the recipient's eligibility through the Eligibility Verification System (EVS) each time the recipient is seen. There are several types of Pennsylvania ACCESS cards providers may encounter. 79 0 obj <> endobj 1. The eligibility request format is called the HIPAA 270 Health Care Eligibility Benefit Inquiry format (also known as 270 Eligibility Inquiry). of May 2011. Payment will not be made for ineligible recipients. This ensures recipients of uninterrupted medical services. Providers can access EVS through the EVS will provide timely validation of the number of countable visits remaining based on actual claims paid at the time of the inquiry. For more information related to EVS, refer to Provider Quick Tip #11 at: http://www.dhs.pa.gov/publications/forproviders/QuickTips/ Q4. The MHX category is only used for tracking mental health service encounter claims for County Mental Health Funded Base Programs. If, however, you use the recipient's social security number and date of birth, you may receive an eligible response because both of these elements are most likely accurate. Please do not assume that the beneficiary is eligible because they present an ACCESS card. The Eligibility Verification System . Please do not assume that the recipient is eligible because he/she has an ACCESS card. The card issue number is voided to prevent misuse when the new card is issued. What if the EVS response displays that a recipient only has service program category MHX and service program EPOMS?The recipient is not MA eligible if they only have EPOMS. benefits for adult MA and adult GA recipients. This is pursuant to the 18 visit limit, during the July 1 through June 30 state fiscal year service period. Pennsylvania Licensing System. Recipients who are eligible for medical benefits only will receive the yellow ACCESS card. The recipient is not MA eligible if they only have EPOMS. 4. Pennsylvania Medical Assistance (MA) PROMISe™ Eligibility Verification System (EVS) Providers can submit individual web interactive EVS requests via the PROMISe™ Internet. The interim card contains the same Recipient Number and Card Issue Number as the previous ACCESS card. %PDF-1.5 %���� A. If not, EVS indicates the number of countable office visits, clinic and home visits remaining within the scope of benefits for adult MA and adult GA recipients. A endstream endobj 80 0 obj <>/Metadata 7 0 R/Pages 77 0 R/StructTreeRoot 16 0 R/Type/Catalog>> endobj 81 0 obj <>/MediaBox[0 0 612 792]/Parent 77 0 R/Resources<>/Font<>/ProcSet[/PDF/Text]/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 82 0 obj <>stream 3. 2. This redesigned card has a background photo of the PA State Capitol building framed by cherry blossom branches. Using the COMPASS questionnaire, those who wish to apply for benefits can see if they or anyone in their household may get approved. Proudly founded in 1681 as a place of tolerance and freedom. Provider Electronic Solutions Software, or through their own certified software. �g�k&�Dm�p�eR���ƣ�L ��(�h{M�`�AWH�B�H֡AU�̢,�0���K8Z�d�q�������2(IA�cHJ@+IŤ�%�F#�Vi���d,Sܐ���ka�,i����V�AK �9�%�dZ��J��Y��L+K���#-�t�'l��S�3#9 �$��0lL��Z0�i�8H+HF+f��!ͬ�CІYK;Ֆa7��~���\g�~��n�.������3���4��l��?֫j2]�9Y5eSM���*{yr��]C��q4/��>TwM�x��إV�6zbN�NB(��f�����\V������džV}[��sr����e�����!Y��K��5��ݕL�H��b�qb>$8�Q�_�i��g�/����n���F��U����t:�X�����C�HF'���u7�������Ĵ�y�����?5�I�]TI�k���_�W�McLr�I�����CD[P�C��|��,k솺�i )�jʇ��tv�P1����)6�e��/�*�Ep���o00��A�-�E3_f��K���. If not, EVS indicates the number of countable office visits, clinic and home visits remaining within the scope of benefits for adult MA and adult GA recipients. The Electronic Benefits Transfer (EBT) card can now have two faces, both of which are valid. �3LΌ��B|00,8Ò��`a_�}��bZ�K ��1�Μ2 �@ �����Hs2��^g�` HV&
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