1.0 INTRODUCTION TO THE NEW YORK STATE MEDICAID ELIGIBILITY VERIFICATION SYSTEM (Rev. 11/02)

New York State operates a Medicaid Eligibility Verification System (MEVS) as a method for providers to verify recipient eligibility prior to provision of Medicaid services. The Identification Card does not constitute full authorization for provision of medical services and supplies. A recipient must present an official Common Benefit Identification Card to the provider when requesting services. The verification process through MEVS must be completed to determine the recipient’s eligibility for Medicaid services and supplies. A provider not verifying eligibility prior to provision of services will risk the possibility of nonpayment for those services. In some instances, a provider not obtaining a service authorization prior to submitting a claim will be denied payment.

The verification process through MEVS can be accessed using one of the following methods:

- the MEVS Terminal (VeriFone).

- a telephone verification process (Audio Response Unit).

- alternate access methods: (CPU-CPU link, batch transmission and PC-Host link).

Information available through MEVS will provide you with:

- The eligibility status for a Medicaid recipient for a specific date (today or prior to today).

- The county having financial responsibility for the recipient (used to determine the contact office for prior approval and prior authorization.)

- Any Medicare, third party insurance or HMO coverage that a recipient may have for the date of service.

- Any limitations on coverage which may exist for the recipient through Utilization Threshold (UT) or Post and Clear (PC) programs and the necessary service authorizations, if applicable.

- Any restrictions to primary providers or exception codes, which further clarify a recipient's eligibility.

- Co-payment information.

- Dispensing Validation Numbers (DVS) for certain Drugs, Durable Medical Equipment, and Dental Services. (Not available via telephone access.)

- The ability to verify or cancel a previously obtained Service Authorization (SA) (not available via ARU).

The above information is not available on the Common Benefit Identification Card issued to the recipient.

MEVS is convenient and easy to use; it is available 24 hours a day, seven days a week.

MEVS is accurate; it provides current eligibility status information for all Medicaid recipients and is updated on a daily basis.

MEVS is responsive; verification information is given in clear, concise and understandable messages.

MEVS should result in a reduction of claims pending or denied due to Medicaid eligibility problems.

This manual is designed to familiarize you with MEVS. The manual contains different sections discussing the Common Benefit Identification Card, the verification equipment, procedures for verification, a description of eligibility responses, definitions of codes, and descriptions of alternate access methods.

2.0 BENEFIT IDENTIFICATION CARDS/FORMS (Rev. 11/02)

The Benefit Identification Cards with which you will need to become familiar are:

- a CBIC permanent plastic photo card.

- a CBIC permanent plastic non-photo card.

- a replacement paper card.

Presentation of a Benefit Identification Card alone is not sufficient proof that a recipient is eligible for services. Each of the Benefit Identification Cards must be used in conjunction with the electronic verification process. If you do not verify the eligibility of each recipient each time services are requested, you will risk the possibility of nonpayment for services which you provide.

In addition, there is a Temporary Medicaid Authorization Form which constitutes full coverage for medical services and does not need to be verified via the electronic process. The following is a detailed description of the Temporary Medicaid Authorization Form and each of the cards.

Temporary Medicaid Authorization Form

In some circumstances, the recipient may present you with a Temporary Medicaid Authorization (TMA) Form DSS-2831A (not pictured). This authorization is issued by the Local Department of Social Services when the recipient has an immediate medical need and a permanent plastic card has not been received by the recipient. The Temporary Medicaid Authorization Form is a guarantee of eligibility and is valid for 15 days. If presented with the authorization form after the time frame specified, the recipient should be requested to present his/her permanent Common Benefit Identification Card.

Providers should always make a copy of the TMA form for their records. Since an eligibility record is not sent to the eMedNY contractor until the CBIC Card is generated, the MEVS system will not have eligibility data for a recipient in TMA status. Note that any claim submitted for payment may pend waiting for the eligibility to be updated. If the final adjudication of the claim results in a denial for recipient eligibility, please contact the New York State Department of Health, Office of Medicaid Management, Local District Support. The phone number for inquiries on TMA issues for recipients residing Upstate is (518)-474-8216. For New York City recipient TMA issues, the number is (212) 268-6855.

2.1 Permanent Common Benefit Identification Photo Card (Rev. 11/02)

The Permanent Common Benefit Identification Photo Card is a permanent plastic card issued to recipients as determined by the Local Department of Social Services. This permanent card has no expiration date. Eligibility must be verified using the MEVS system.

COMMON BENEFIT IDENTIFICATION PHOTO CARD DESCRIPTION
ID Number	Eight-digit number assigned by the State of New York which identifies each individual Medicaid recipient. This number contains both alpha and numeric digits. This is the Client Identification Number (Medicaid number) to be used for billing purposes. Client ID # must be two alpha, five numeric and one alpha.
Sex	One letter character indicating the sex of the recipient. This character is located on the same line as date of birth. M = Male F = Female U = Unborn (Infant)
Date of Birth	Recipient’s date of birth, presented in MMDDCCYY format. Example: August 15, 1980 is shown as 08-15-1980. Unborns (Infants) are identified by 00000000. The date is located on the same line as sex.
Last Name	Last name of the recipient who will use this card for services.
First, M.I.	First name and middle initial of the person named above.
Signature	Electronic Signature of cardholder, parent, or guardian.
ISO#	Six-digit number assigned to the New York State Department of Health (DOH). Disregard when manually entering access number for Medicaid verification.
Access Number	Thirteen-digit number used for entry into the Medicaid Eligibility Verification System. The access number is not used for billing.
Sequence Number	Two-digits at the end of the access number. This number is used in the entry process of access number and client number (CIN) verifications.
Photo	Photograph of the individual cardholder.
Magnetic Stripe	Stripe with enclosed information that is read by the MEVS terminal.
Signature Panel	Must be signed by the individual cardholder, parent or guardian to be valid for services.

2.2 Permanent Common Benefit Identification Non-Photo Card (Rev. 11/02)

The Common Benefit Identification Non-Photo Card is a permanent plastic card issued to recipients as determined by the Local Department of Social Services. This permanent card has no expiration date. Eligibility must be verified using the MEVS system.

COMMON BENEFIT IDENTIFICATION NON-PHOTO CARD DESCRIPTION
ID Number	Eight-digit number assigned by the State of New York, which identifies each individual recipient. This is the Client Identification Number (Medicaid number) to be used for billing purposes. Client ID # must be two alpha, five numeric and one alpha.
Sex	One letter character indicating the sex of the recipient. This character is located on the same line as date of birth. M = Male F = Female U = Unborn (Infant)
Date of Birth	Recipient’s date of birth, presented in MMDDCCYY format. Example: August 15, 1980 is shown as 08-15-1980. Unborns (Infants) are identified by 00000000. The date is located on the same line as sex.
Last Name	Last name of the recipient who will use this card for services.
First, M.I.	First name and middle initial of the person named above.
ISO#	Six-digit number assigned to the New York State Department of Health (DOH). Disregard when manually entering access number for Medicaid verification.
Access Number	Thirteen-digit number used for entry into the Medicaid Eligibility Verification System. The access number is not used for billing purposes.
Sequence Number	Two-digits at the end of the access number. This is used in the entry process of access number and client number (CIN) verifications.
Magnetic Stripe	Stripe with encoded information that is read by the MEVS terminal.
Signature Panel	Must be signed by the individual cardholder, parent or guardian to be valid for services.

1.0 INTRODUCTION TO THE NEW YORK STATE MEDICAID ELIGIBILITY VERIFICATION SYSTEM (Rev. 11/02)

2.0 BENEFIT IDENTIFICATION CARDS/FORMS (Rev. 11/02)

2.1 Permanent Common Benefit Identification Photo Card (Rev. 11/02)

2.2 Permanent Common Benefit Identification Non-Photo Card (Rev. 11/02)

2.3 Replacement Common Benefit Identification Card (Rev. 11/02)