NEW YORK STATE PROGRAMSMEVS INSTRUCTIONS FOR COMPLETING A TELEPHONE TRANSACTION· Be sure to convert all alpha characters to
numeric prior to dialing. · Press * (asterisk key) once to clear
a mistake; or to repeat a response. · 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 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. · For description or clarification of any
response, see the MEVS Provider Manual. · Nonapplicable prompts may be bypassed by
pressing #. · To be transferred directly 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. · To begin the transaction, Dial
1-800-997-1111
ALPHA
CONVERSION CHART A = 21 H
= 42 O = 63 V = 83 B = 22 I
= 43 P = 71 W = 91 C = 23 J
= 51 Q = 11 X = 92 D = 31 K
= 52 R = 72 Y = 93 E = 32 L
= 53 S = 73 Z = 12 F = 33 M
= 61 T = 81 G = 41 N
= 62 U = 82 NEW YORK
STATE MEDICAID None IF
ENTERING ALPHANUMERIC (CIN) IDENTIFIER, ENTER NUMBER 1 Enter 1 or 2 IF
ENTERING NUMERIC IDENTIFIER Press
#. (ACCESS
#) ENTER NUMBER 2 ENTER
IDENTIFICATION NUMBER Enter
the client’s converted alphanumeric Medicaid number (CIN) or numeric access
number. Press #. ENTER NUMBER 1 FOR SERVICE
AUTHORIZATION
OR NUMBER 2 FOR Enter 1 or 2. Press #.
ELIGIBILITY
INQUIRY 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 verification on a previous date of
service. Press #. ENTER
PROVIDER NUMBER Enter
Provider Identification Number. Press #. ENTER
SPECIALTY CODE If
applicable, enter the three-digit specialty code and press #, or press # to
bypass. ENTER REFERRING PROVIDER Enter the Medicaid provider number of the
NUMBER referring
provider. Press #. If
the client is not a referral, press # to bypass this prompt. ENTER
FIRST CO-PAYMENT TYPE Enter
the converted co-payment type or press # to bypass the rest of the co-payment
prompts. ENTER
CO-PAYMENT UNITS Enter
the number of units being rendered or press # to bypass the rest of the
co-payment prompts. ENTER
SECOND CO-PAYMENT TYPE Enter
the converted co-payment type or press # to bypass the rest of the co-payment
prompts. ENTER
CO-PAYMENT UNITS Enter
the number of units being rendered or press # to bypass the rest of the
co-payment prompts. RESPONSES (contd.)
TELEPHONE RESPONSE DESCRIPTION/COMMENTS MEDICAID
ELIGIBLE HR UTILIZATION Client
is eligible to receive all Medicaid services THRESHOLD with
prescribed limits. A service authorization must be obtained for services
limited under Utilization Threshold. MEDICARE
COINSURANCE AND Client
is eligible for payment of Medicare DEDUCTIBLE
ONLY coinsurance
and deductibles only. OUTPATIENT COVERAGE WITH Client is eligible for most ambulatory care, COMMUNITY BASED
LONG TERM CARE including prosthetics, and short-term
rehabilitation with limitations. See MEVS Provider Manual for limited and
excluded services. OUTPATIENT COVERAGE WITHOUT Client is eligible for some ambulatory care, LONG TERM
CARE prosthetics,
and short-term rehabilitation services. See
MEVS Provider Manual for excluded services. OUTPATIENT
COVERAGE WITH NO Client is eligible for all ambulatory
care, including NURSING FACILITY SERVICES prosthetics. See
MEVS Provider Manual for excluded services. PERINATAL
FAMILY Client
is eligible to receive a limited package of benefits. See MEVS Provider
Manual for excluded services. PRESUMPTIVE
ELIGIBLE LONG- Client
is eligible for all Medicaid services except TERM/HOSPICE hospital
based clinic services, hospital emergency room services, hospital inpatient
services, and bed reservation. PRESUMPTIVE
ELIGIBILITY Client
is eligible to receive all Medicaid services PRENATAL
A except
inpatient care, institutional long-term care, alternate level care, and
long-term home health care. PRESUMPTIVE
ELIGIBILITY Client
is eligible to receive only ambulatory PRENATAL
B prenatal
care services. See MEVS Provider Manual for excluded services. ANNIVERSARY
MONTH OCTOBER This
is the beginning month of the client’s benefit year. CATEGORY OF ASSISTANCE S Client is enrolled in the SSI assistance
program. MEDICARE PART A Client has only Part A
Medicare. MEDICARE
PART B Client
has only Part B Medicare. MEDICARE
PARTS A and B Client
has both Parts A and B. MEDICARE
PARTS A & B & QMB Client
has Part A and B Medicare coverage and is a Qualified Medicare Beneficiary
(QMB). MEDICARE
PART A & QMB Client
has Part A Medicare coverage and is a Qualified Medicare Beneficiary (QMB). MEDICARE
PART B & QMB Client
has Part B Medicare coverage and is a Qualified Medicare Beneficiary (QMB). MEDICARE
QMB ONLY Client
is a Qualified Medicare Beneficiary (QMB) Only. HEALTH
INSURANCE CLAIM NUMBER Health
Insurance Claim number. XXXXXXXXXXXX |
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VOICE PROMPT ACTION/INPUT ENTER
THIRD CO-PAYMENT TYPE Enter
the converted co-payment type or press # to bypass the rest of the co-payment
prompts. ENTER
CO-PAYMENT UNITS Enter
the number of units being rendered or press # to bypass the rest of the
co-payment prompts. ENTER
FOURTH CO-PAYMENT TYPE Enter
the converted co-payment type or press # to bypass the rest of the co-payment
prompts. ENTER
CO-PAYMENT UNITS Enter
the number of units being rendered or press # to bypass the rest of the
co-payment prompts. ENTER
NUMBER OF SERVICE UNITS Enter
the total number of service units rendered. Press #. IF YOU ARE A DESIGNATED POSTING If you are a designated Posting
Provider, Enter PROVIDER, ENTER NUMBER OF LAB the total number of Lab
tests being ordered and TESTS YOU ARE ORDERING Press# or Press # to
bypass. IF YOU ARE A DESIGNATED POSTING If you are a designated Posting
Provider, Enter PROVIDER, ENTER NUMBER OF the total number of
prescriptions or over the PRESCRIPTIONS OR OVER THE counter items being
ordered and Press #, COUNTER ITEMS YOU ARE ORDERING or Press # to bypass. ENTER ORDERING PROVIDER Enter the MMIS Provider
Identification Number or NUMBER Profession
Code and License Number of the ordering provider, if applicable. Press # or
Press # to bypass. ************************************************************************************************************ ************************************************************************************************************ RESPONSES
TELEPHONE RESPONSE DESCRIPTION/COMMENTS MEDICAID
NUMBER AA22346D The
response begins with the client’s eight-digit Medicaid CIN. COUNTY
CODE XX Client’s
two-digit county code. COMMUNITY COVERAGE WITH Client is eligible to receive most Medicaid services. See COMMUNITY
BASED LONG TERM CARE MEVS Provider Manual for excluded
services. COMMUNITY COVERAGE WITHOUT Client is eligible for acute inpatient care, care in a LONG TERM
CARE psychiatric center,
some ambulatory care, prosthetics, and short-term rehabilitation services.
See MEVS Provider Manual for excluded services. ELIGIBLE CAPITATION GUARANTEE Indicates guaranteed
status under a Prepaid Capitation Program (PCP). ELIGIBLE EXCEPT NURSING FACILITY Client is
eligible to receive all Medicaid services except SERVICES nursing
facility services provided in a SNF or inpatient setting.
See MEVS Provider Manual for limited and excluded
services. ELIGIBLE
ONLY FAMILY PLANNING Client
is eligible for Medicaid covered family SERVICES planning
services. ELIGIBLE
ONLY OUTPATIENT CARE Client
is eligible for all ambulatory care, including prosthetics, no inpatient
coverage. ELIGIBLE
PCP Client
covered by a Prepaid Capitation Program (PCP) as well as eligible for limited
fee-for-service benefits. EMERGENCY SERVICES ONLY Client is eligible for
emergency services only. FAMILY HEALTH PLUS Client
is enrolled in the Family Health Plus Program (FHP). MEDICAID ELIGIBLE Client is eligible for all
benefits. RESPONSES (contd.)
TELEPHONE RESPONSE DESCRIPTION/COMMENTS HEALTH
INSURANCE CLAIM NUMBER Health
Insurance Claim number is not on file. NOT ON FILE
INSURANCE
COVERAGE CODE 21: Insurance
and Coverage Codes equal the DENTAL,
PHYSICIAN, INPATIENT Insurance
carrier and the scope of benefits. EXCEPTION
CODE 35 Client’s
exception and/or restriction code. NO
CO-PAYMENT REQUIRED Client
is under 21 or exempt from co-payment and co-payment data has been entered. CO-PAYMENT
REQUIREMENTS MET Client
has reached his/her co-payment maximum. ON
MM/DD/YY AT
SERVICE LIMIT The client has reached his/her limit for that
particular service category. No service authorization is created. DUPLICATE
– UT PREVIOUSLY Request
is a duplicate of a previously approved APPROVED service
authorization. PARTIAL
APPROVAL XX SERVICE Indicates that the full complement of requested UNIT(S),
XX LAB UNIT(S), XX services relative to Post and Clear processing is PHARMACY
UNIT(S) POST AND not
available. The XX represents the number of CLEAR services
approved/available. PARTIAL
APPROVAL XX SERVICE Indicates that the full complement of requested UNIT(S),
XX LAB UNIT(S), XX services relative to Utilization Threshold PHARMACY
UNIT(S) UTILIZATION processing
is not available. The XX
represents THRESHOLD the
number of services approved/available. SERVICE
APPROVED NEAR LIMIT The
service authorization has been granted and XX
SERVICE UNIT(S), XX LAB UNIT(S), recorded. The client has almost reached his/her XX
PHARMACY UNIT(S) service
limit for that particular category. SERVICE
APPROVED UTILIZATION The
service units requested are approved. THRESHOLD
XX SERVICE UNIT(S),
XX
LAB UNIT(S), XX PHARMACY UNIT(S)
SERVICES
APPROVED POST AND The
ordering provider has posted services and the CLEAR XX
SERVICE UNIT(S), XX LAB units
have been approved. UNIT(S),
XX PHARMACY UNIT(S) FOR DATE
MMDDYY The
date for which services were requested will be heard when message is
complete. Press
# to repeat entire message. ************************************************************************************************************ ************************************************************************************************************ ERROR
RESPONSES TELEPHONE
RESPONSE DESCRIPTION/COMMENTS CALL
800-343-9000 When
certain conditions are met (ex: multiple responses), you need to call the
Provider Services staff for additional data. DECEASED
ORDERING PROVIDER The
Ordering Provider is deceased. DISQUALIFIED
ORDERING The
Ordering Provider is identified as excluded/ PROVIDER disqualified
and cannot prescribe. EXCESSIVE
ERRORS, REFER TO Too
many invalid entries. Refer to the input data MEVS
MANUAL OR CALL 800-343- section
or call 1-800-343-9000. 9000 FOR ASSISTANCE |
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ERROR
RESPONSES (contd.) TELEPHONE
RESPONSE DESCRIPTION/COMMENTS INVALID ACCESS METHOD The received
transaction is classified as a Provider Type/Transaction Type Combination
that is not allowed to be submitted through the telephone. INVALID
ACCESS NUMBER Incorrect
access number. INVALID
CARD THIS RECIPIENT Client
has used an invalid card. INVALID CO-PAYMENT Invalid
number of digits or number doesn't convert to an alpha character. To proceed,
re-enter the data in the correct format. INVALID
CO-PAYMENT, REFER TO The
Data entered is not a valid Co-payment value. MEVS
MANUAL INVALID
DATE Illogical
date or a date which falls outside of the allowed inquiry period of 24
months. INVALID ENTRY An
invalid number of digits was entered for service units. INVALID IDENTIFICATION NUMBER The client identification number
not valid. INVALID PROFESSION
CODE Profession
Code not valid. INVALID
MEDICAID NUMBER Medicaid
number (CIN) not valid. INVALID
MENU OPTION An
invalid entry was made when selecting the identifier type. INVALID ORDERING PROVIDER Ordering Provider
Identification Number or license NUMBER number
entered NUMBER was not found on the file. INVALID
PROVIDER NUMBER Provider
Identification Number invalid. INVALID
REFERRING PROVIDER Referring
Provider Identification Number invalid. NUMBER
INVALID
SEQUENCE NUMBER The
sequence number entered is not valid or not current. INVALID
SPECIALTY CODE The
specialty code was either entered incorrectly, or not associated with the
provider’s category of service, or the provider is a clinic and a required
specialty was not entered. MCCP
RECIPIENT NO Client
is restricted. Services must be provided, AUTHORIZATION ordered,
or referred by the primary provider. NO COVERAGE EXCESS INCOME Client has an income in
excess of the allowable levels
and must spenddown the excess in order to be
eligible. NO
COVERAGE PENDING FAMILY Client is
waiting to be enrolled into a Family Health HEALTH PLUS Plus
Managed Care Plan. NO SERVICE UNITS ENTERED No entry was made and
the units are required for this
transaction. NOT
MEDICAID ELIGIBLE Client
is not eligible for benefits on the date of service entered. |
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ERROR
RESPONSES (contd.) TELEPHONE RESPONSE DESCRIPTION/COMMENTS PRESCRIBING PROVIDER License
number is not active for the date of service LICENSE NOT IN ACTIVE STATUS entered. PROVIDER
INELIGIBLE FOR The
category of service for the Provider identification SERVICE ON DATE
PERFORMED number
submitted in the transaction is inactive or invalid
for the date of service entered. PROVIDER
NOT ELIGIBLE The
verification was attempted by an inactivated or disqualified provider. PROVIDER
NOT ON FILE The
Provider Identification Number entered is not identified as a Medicaid
enrolled provider. RECIPIENT
NOT ON FILE Client
identification number (CIN) is not on file. The number is either incorrect or
the client is no longer eligible and the number is no longer on file. REENTER
ORDERING PROVIDER Ordering
provider number or license number has an NUMBER incorrect
format (wrong length or characters in the wrong position). RESTRICTED RECIPIENT NO Enter the MMIS
Provider Identification Number to AUTHORIZATION whom
the client is restricted. SERVICES
NOT ORDERED The
ordering provider did not post the services you are trying to clear. SSN ACCESS NOT ALLOWED The provider is not
authorized to access the system using a social security number. SSN NOT ON FILE The
entered nine-digit number is not on the Client Master file. SYSTEM
ERROR # A
network problem exists. Call 1-800-343-9000 with the error number. THE
SYSTEM IS CURRENTLY System
is unavailable. After hearing this message UNAVAILABLE.
PLEASE CALL you will
be disconnected. 800-343-9000
FOR ASSISTANCE |
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NEW YORK STATE PROGRAMSMEVS INSTRUCTIONS USING VERIFONE Omni 3750 ·
ENTER key must
be pressed after each field entry. ·
For assistance or further information on input or response
messages, call Provider Services staff, 1-800-343-9000. ·
To add provider numbers to your terminal, call 1-800-343-9000. (Please maintain a
listing of provider numbers and associated values.) ·
To enter a number, press the key with the desired number. ·
To enter a letter, press the key with the desired letter,
and then press the alpha key until the letter appears in the display window. PROMPT DISPLAYED ACTION/INPUT To
begin, press the RED key, press
the F4 key to start the
verification. ENTER
CARD OR ID If
you are using the client’s access number then swipe the card through reader,
or key the access number then press the ENTER
key. If
you are using the Client’s Medicaid number (CIN), enter the Medicaid number
and press the ENTER key. ENTER
TRAN TYPE One
of the following must be entered: 1 Service Authorization and Eligibility
inquiry. 2 Eligibility inquiry only. 3 Authorization Confirmation. 4 Authorization Cancellation. 6
Dispensing Validation System (DVS) Request. 7
Service Authorization and Eligibility inquiry. (Lab
& Pharmacies) Press
the ENTER key. Note: Depending on which Tran Type you select, the
following prompts may not appear in the order in which they are listed. ENTER SEQ
# If
you are using the Medicaid Number (CIN), enter the two-digit sequence number
and press the ENTER key. Note:
This prompt will not appear if the Access number was entered as it contains
the sequence number. ENTER
DATE Press
ENTER for today’s date or enter
MMDDCCYY for verification on a previous date of service. Press the ENTER key. SELECT
PROVIDER If
you see this prompt there are multiple provider numbers programmed into this
terminal. Enter the appropriate number associated with your Provider
Identification Number or enter an eight-digit MMIS Provider Identification
Number and press the ENTER key (To
add numbers call 1-800-343-9000) ENTER
TAXONOMY CODE This
code is used for classifying health care providers according to provider type
or practitioner specialty. SERVICE TYPE Enter
the code identifying the type of service you are providing. ORDERING
PRV # Enter
the MMIS Provider Identification Number or Profession Code and State license
number of the ordering provider, if applicable. Press the ENTER key. |
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PROMPT DISPLAYED ACTION/INPUT REFERRING
PRV # Enter
the Medicaid provider number of the referring provider. For Restricted
Clients, enter their Primary Provider’s number. Press the ENTER key. COPAY
EXEMPT 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, enter 1 for yes.
If the client is not exempt from co-payment, enter 2 for no. Note: Bypassing this prompt will enter a 2 for no. # SERVICE
UNITS Enter
the total number of service units. Press the
ENTER key. Note: The
following two prompts are required for DVS transactions only and will only appear when Tran Type 6 is entered. ENTER
ITEM/NDC # Enter
the five-digit New York State alpha/numeric item code of the item being
dispensed. For some items, if instructed by New York State, the
Eleven-digit National Drug Code may be entered. For
Dental DVS: Enter a constant value of ‘D’; the five character Dental
procedure code; and a two-digit tooth number, a one character primary tooth,
or two character tooth quadrant/arch. | |||