1.0 INTRODUCTION TO THE NEW YORK STATE MEDICAID ELIGIBILITY VERIFICATION SYSTEM (Rev. 10/03)

New York State operates a Medicaid Eligibility Verification System (MEVS) as a method for providers to verify client eligibility prior to provision of Medicaid services. The Identification Card does not constitute full authorization for provision of medical services and supplies. A client 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 client’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, PC-Host link and ePACES).

Information available through MEVS will provide you with:

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

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

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

- Any limitations on coverage which may exist for the client 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 client'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 client.

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 clients 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.

ALTERNATE ACCESS TO MEVS (Rev. 02/05)

Additional alternative methods of access allow providers to use their own equipment to access MEVS. The following is a brief description of these alternate access methods.

· ePACES

Refer to ePACES on http://www.emedny.org/HIPAA/SupportDocs/ePACES.html

· CPU-CPU LINK

This method is for providers who want to link their computer system to the MEVS contractor's computer system via a dedicated communication line. Upon receiving a MEVS verification request, the MEVS contractor sends back a response within seconds.

CPU-CPU link is suggested for service bureaus and high volume (5,000 to 10,000 transactions per day) providers.

· eMedNY eXchange

This method allows users to transfer files from their computer via a web-based interface. Users are assigned an “inbox” and are able to send and receive transaction files in an email-like fashion. Transaction files are “attached” and sent to eMedNY for processing. Responses are delivered to the user’s inbox, and can be downloaded to the user’s computer.

· Batch Transmission

This method is the standard process for batch authorization transmissions. FTP allows users to transfer files from their computer to another computer (upload) or from another computer to their computer (download). Each batch file transmission sent to the eMedNY contractor is required to be completed within two hours. Any transmission exceeding two hours will be disconnected.

· PC-HOST LINK

This method requires a PC, a dial up modem, and a specific message format. Verification requests are transmitted to the MEVS contractor one transaction at a time. Verification responses are returned within seconds.

The PC-Host method is suggested for low volume (under 500 transactions per month) and medium volume (500-2,000 transactions per month) providers. It is also recommended for providers who want to capture Medicaid information electronically to combine with billing and claims processing.

For further information about alternate access methods and the approval process, please call 1-800-343-9000.

2.0 BENEFIT IDENTIFICATION CARDS/FORMS (Rev. 10/05)

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 client 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 client 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 client 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 client has an immediate medical need and a permanent plastic card has not been received by the client. 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 client 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 client 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 client eligibility, please contact the New York State Department of Health, Office of Health Insurance Programs, Local District Support. The phone number for inquiries on TMA issues for clients residing Upstate is (518)-474-8887. For New York City client TMA issues, the number is (212) 417-4500.

2.1 Permanent Common Benefit Identification Photo Card (Rev. 10/03)

The Permanent Common Benefit Identification Photo Card is a permanent plastic card issued to clients 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 client. This number contains both alpha and numeric digits. This is the Client Identification Number (CIN) 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 client. This character is located on the same line as date of birth. M = Male F = Female U = Unborn (Infant)
Date of Birth	Client’s date of birth, presented in MM/DD/YY 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 client 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 (including the 2 digit sequence 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. 10/03)

The Common Benefit Identification Non-Photo Card is a permanent plastic card issued to clients 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 client. This is the Client Identification Number (CIN) 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 client. This character is located on the same line as date of birth. M = Male F = Female U = Unborn (Infant)
Date of Birth	Client’s date of birth, presented in MM/DD/YY 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 client 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 (including the 2 digit sequence 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 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.

2.3 Replacement Common Benefit Identification Card (Rev. 10/03)

The Replacement Common Benefit Identification Card is a temporary paper card issued by the Local Department of Social Services to a client. This card will be issued when the Permanent Common Benefit Identification Card is lost, stolen or damaged. When using the MEVS terminal for eligibility verification, all information will need to be entered manually.

REPLACEMENT COMMON BENEFIT IDENTIFICATION CARD DESCRIPTION
ID Number	Eight-digit number assigned by the State of New York which identifies each individual client. This is the Client Identification Number (CIN) 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 client. This character is located on the same line as date of birth. M = Male F = Female U = Unborn (Infant)
Date of Birth	Client’s date of birth, presented in MM/DD/YY format. Example: August 15, 1980 is shown as 08/15/1980. Unborns (Infants) are identified by 00000000.
Name	Name of the client who will be able to use this card for services.
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 (including the 2 digit sequence 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.
Expiration Date	Date the temporary card expires.
Signature Panel	Must be signed by the individual cardholder, parent or guardian to be valid for services.

Note: When verifying a client’s eligibility be aware of the expiration date on the front of the card. The card is not valid if the date has expired. A response “INVALID CARD THIS RECIPIENT” will be returned.

3.0 INTRODUCTION TO TELEPHONE (Audio Response Unit) VERIFICATION (Rev. 10/03)

Verification requests for client eligibility may be entered into the MEVS system through a touch-tone telephone. This access method is suggested for providers with very low transaction volume (under 50 transactions per month). For convenience, providers with higher volumes should use the VeriFone Terminal or refer to Alternate Access to MEVS on page 1.0.2.

Access to the Telephone Verification System (Rev. 02/05)

A toll free number has been established for both New York State and Out of State Providers. To access the system, dial 1-800-997-1111.

If you wish to be transferred directly to an eMedNY Provider Services Representative, you may press “0” on the telephone keypad at any time during the first four prompts.

The following message will be heard:

“The ARU Zero Out Option”

You will then be connected to the eMedNY Provider Services Helpdesk.

If you are unable to connect to MEVS by dialing the above primary number, dial the back-up number, 1-800-225-3040. This back-up number must only be used when the primary number is not working. Once you complete your verification, you must return to using the primary number.

If the connection is unsuccessful using either number, call Provider Services at 1-800-343-9000.

3.2 Telephone Verification Using the Access Number or Medicaid Number (CIN) (Rev. 10/03)

The access number is a thirteen-digit numeric identifier on the Common Benefit Identification Card that includes the sequence number. The easiest and fastest verification method is by using the access number.

The Medicaid number (CIN) is an eight-digit alpha/numeric identifier on the Common Benefit Identification Card. The Medicaid number (CIN) can also be used to verify a client’s eligibility. You must convert the eight-digit identifier to a number with eleven-digits. The three letters are the only characters converted in the number. You should refer to the chart below when converting the Medicaid number (CIN). For example:

A D 12345 Z = eight-digit Medicaid number (CIN)

21 31 12345 12 = becomes an eleven-digit number

For this example, the chart indicates that the letter A = 21, D = 31 and Z = 12. Replace the letters A, D and Z with the numbers 21, 31 and 12 respectively. The converted number is 21311234512

ALPHA CONVERSION CHART
	A	=	21	N	=	62
	B	=	22	O	=	63
	C	=	23	P	=	71
	D	=	31	Q	=	11
	E	=	32	R	=	72
	F	=	33	S	=	73
	G	=	41	T	=	81
	H	=	42	U	=	82
	I	=	43	V	=	83
	J	=	51	W	=	91
	K	=	52	X	=	92
	L	=	53	Y	=	93
	M	=	61	Z	=	12

Note: Perform the required conversion before dialing MEVS.

3.3 Telephone Verification Input Section (Rev. 02/05)

Instructions for Completing a Telephone Transaction

• If using a CIN, be sure to convert the number before dialing. Refer to the chart on the previous page.

• Dial 1-800-997-1111.

• Once you have dialed and a connection is made, an Audio Response Unit (ARU) will prompt you for the input data that needs to be entered.

• If you wish to hear a prompt repeated, press *, (asterisk).

• To bypass a prompt, press #, (the pound key).

• To clear a mistake, press the * key and re-enter the correct information. This step is only valid if done prior to pressing the # key which registers the entry.

• Once you are familiar with the prompts and wish to make your entries without waiting for the prompts, just continue to enter the data in the proper sequence. As in all transactions (prompted or unprompted), press the # key after each entry.

• For assistance or further information on input or response messages, call the Provider Services staff at 1-800-343-9000.

• For some prompts, if the entry is invalid, the ARU will repeat the prompt. This allows you to correct the entry without re-keying the entire transaction.

• The call is terminated if excessive errors are made.

· To be transferred to an eMedNY Provider Services Representative, press “0” on the telephone keypad at any time during the first four prompts. The following message will be heard: “The ARU Zero Out Option”. You will then be transferred to the eMedNY Provider Services Helpdesk.

• If you will be entering co-payment information, be sure to convert the alpha co-payment type to a number, prior to dialing. Refer to Section 13.1 on page 13.0.1 for Co-payment Type codes.

• The following types of transactions cannot be processed via the telephone:

• Cancel Transactions

• Authorization Confirmation Transactions

• Dispensing Validation System Transactions

Note: Detailed instructions for entering a transaction begin on the next page. The Voice Prompt column lists the instructions you will hear once your call is connected. The Action/Input column describes the data you should enter.

VOICE PROMPT	ACTION/INPUT
	TO BEGIN Dial 1-800-997-1111
NEW YORK STATE MEDICAID	None
IF ENTERING ALPHA/NUMERIC IDENTIFIER, ENTER NUMBER 1 IF ENTERING NUMERIC IDENTIFIER, ENTER NUMBER 2	Enter 1, If using converted CIN. Enter 2, If using Access Number.
ENTER IDENTIFICATION NUMBER	Enter converted alpha/numeric Medicaid number (CIN) or numeric access number. Press #.
ENTER NUMBER 1 FOR SERVICE AUTHORIZATION OR NUMBER 2 FOR ELIGIBILITY INQUIRY	One of the following transaction types must be entered: 1 To request a Service Authorization as well as Eligibility Information. This must be used to obtain a service authorization for Post and Clear (P & C) and Utilization Threshold (UT). Co-payment entries may also be made using this transaction type. 2 To request Eligibility Information only. This may also be used to determine if ordered/prescribed services are available for the client under the UT program. Co-payment entries can also be made using this transaction type.
ENTER SEQUENCE NUMBER	If the Identification Number entry was a Medicaid Number (CIN), enter the two-digit sequence number. No entry is necessary if the numeric Access Number was entered. Press # to bypass the prompt.
ENTER DATE	Press # for today's date or enter MMDDYY for a previous date of service. For all inpatient co-payment entries, the date should equal the discharge date.
ENTER PROVIDER NUMBER	Enter the eight-digit provider identification number assigned at the time of enrollment in the NYS Medicaid Program.
ENTER SPECIALTY CODE	Enter the three-digit MMIS specialty code that describes the type of service that will be rendered and press #. If you are providing a service that is exempt from the UT program or you are a clinic or hospital clinic using a transaction type 1, a code MUST be entered. If you do not have a specialty code, press # to bypass this prompt.
ENTER REFERRING PROVIDER NUMBER	Must be entered if the client is in the Restricted Recipient Program and the transaction is not done by the primary provider. Enter the Medicaid provider number of the primary provider and press #. If a client enrolled in the Managed Care Coordinator Program (MCCP) is referred to you by the primary provider, you must enter that provider's ID number in response to this prompt. If the client is not a referral, press the # key to bypass this prompt.
ENTER FIRST CO-PAYMENT TYPE	Enter the alpha converted co-payment type. Refer to Section 13.1 on page 13.0.1 for Co-payment Type codes. If the service you are rendering does not require co-payment, or if the client is exempt or has met their co-payment maximum responsibility, bypass all the co-payment prompts by pressing #.
ENTER CO-PAYMENT UNITS	Enter the number of units being rendered. Only a one or two-digit numeric entry is acceptable. If the first entry is valid, you will be prompted to enter “SECOND CO-PAYMENT TYPE”, then a “THIRD CO-PAYMENT TYPE” and finally “FOURTH CO-PAYMENT TYPE”. The additional co-payment prompts would be used by a provider who is rendering more than one co-payment type of service. If not applicable, press # to bypass the rest of the co-payment prompts.
ENTER SECOND CO-PAYMENT TYPE	Enter the alpha converted co-payment type for the second co-payment and press #.
ENTER CO-PAYMENT UNITS	Enter the number of units being rendered. Only a one or a two-digit numeric entry is acceptable. Press #.
ENTER THIRD CO-PAYMENT TYPE	Enter the alpha converted co-payment type for the third co-payment and press #.
ENTER CO-PAYMENT UNITS	Enter the number of units being rendered. Only a one or two-digit numeric entry is acceptable. Press #.
ENTER FOURTH CO-PAYMENT TYPE	Enter the alpha converted co-payment type for the fourth co-payment and press #.
ENTER CO-PAYMENT UNITS	Enter the number of units being rendered. Only a one or two-digit numeric entry is acceptable. Press #.
ENTER NUMBER OF SERVICE UNITS	Enter the total number of service units rendered and press #. If you are performing an eligibility inquiry only, press # to bypass this prompt.
IF YOU ARE A DESIGNATED POSTING PROVIDER, ENTER NUMBER OF LAB TESTS YOU ARE ORDERING	If you are a designated Posting Provider, enter the total number of Lab tests being ordered and press #, or press # to bypass.
IF YOU ARE A DESIGNATED POSTING PROVIDER ENTER NUMBER OF PRESCRIPTIONS OR OVER THE COUNTER ITEMS YOU ARE ORDERING	If you are a designated Posting Provider, enter the total number or prescriptions or over the counter items being ordered and press #, or press # to bypass.
ENTER ORDERING PROVIDER NUMBER	Enter the MMIS Provider ID of the ordering provider and press #. All providers who fill written orders/scripts must complete this field. If you do not have the provider number of the ordering provider, you may enter the profession code and license number. If entering a license number for New York State providers, after entering a profession code, enter two zeros and the six-digit license number. If entering out of state license numbers, after entering the profession code, enter the two character converted alpha state code (see page 3.2.1), followed by the license number. A Nurse Practitioner must have a “F” preceding their license number in order to prescribe drugs. If entering a NYS nurse practitioner license number, enter the profession code followed by 33 (converted F) and then the license number. NYS Optometrists who are allowed to prescribe certain medications will have an alpha character (U or V) preceding their license number. When entering their license number, enter the profession code, convert the alpha character to a number (see page 3.2.1) and enter that number followed by the actual license number. Examples MMIS Provider ID 01234567 New York State License # 06000987654 Out of State License # 0606251345678 Nurse Practitioner # 04233421212 NYS Optometrist # 05683452749 Press # to bypass this prompt if you are not a dispensing provider.
NOTE: When entering a profession code and license number, the last six positions of the entry should be the actual numeric license number. If the license number does not contain six numbers, zero fill the appropriate positions preceding the actual license number. For example, an entry for an Optometrist whose license number is V867 would be: 05683000867 (Profession Code + V + Zero fill + License Number).

THIS IS THE LAST PROMPT YOU WILL HEAR. THE MEVS SYSTEM WILL NOW RETURN YOUR RESPONSE.

THIS ENDS THE INPUT DATA SECTION.

MESSAGE SEQUENCE	RESPONSE	DESCRIPTION/COMMENTS
CIN	MEDICAID NUMBER AA22346D