STATE OF NEW YORK                        

DEPARTMENT OF HEALTH

 

 

 

 

 

eMedNY

MEVS Provider Manual

 

 


Table of Contents

 

Section

1.0 INTRODUCTION TO THE NEW YORK STATE MEDICAID ELIGIBILITY VERIFICATION SYSTEM    1.0.1

2.0 BENEFIT IDENTIFICATION CARDS/FORMS. 2.0.1

2.1     Permanent Common Benefit Identification Photo Card.. 2.1.1

2.2     Permanent Common Benefit Identification Non-Photo Card.. 2.2.1

2.3     Replacement Common Benefit Identification Card.. 2.3.1

3.0 INTRODUCTION TO TELEPHONE (Audio Response Unit) VERIFICATION.. 3.0.1

3.1     Telephone Equipment Specifications. 3.1.1

3.2     Telephone Verification Using the Access Number or Medicaid Number (CIN) 3.2.1

3.3     Telephone Verification Input Section.. 3.3.1

3.4     Telephone Verification Response Section.. 3.4.1

3.5     Telephone Verification Error and Denial Responses. 3.5.1

4.0 INTRODUCTION TO THE Verifone Omni 3750 MEVS Terminal.. 4.0.1

5.0 Quick Start.. 5.0.1

6.0 VeriFone Omni 3750 Terminal.. 6.0.1

6.1     VeriFone Omni 3750 Terminal - Front. 6.0.1

6.1.1   VeriFone Omni 3750 Terminal Description - Front. 6.0.2

6.2     VeriFone Omni 3750 Terminal – Back.. 6.0.3

7.0 VeriFone Installation Instructions. 7.0.1

7.1     Instructions to Reset Day/Date/Time. 7.1.1

7.2     Instructions for Setup Menu (P1 Key) 7.2.1

7.3     Instructions for Provider Menu (P2 key) 7.3.1

8.0 VeriFone Verification Input Section.. 8.0.1

8.1     VeriFone Verification Using the Access Number or Medicaid Number (CIN) 8.0.1

8.2     Instructions for Completing a VeriFone Transaction.. 8.0.1

8.2.1   Instructions for Completing Tran Type 1. 8.2.1.1

8.2.2   Instructions for Completing Tran Type 2. 8.2.2.1

8.2.3   Instructions for Completing Tran Type 3. 8.2.3.1

8.2.4   Instructions for Completing Tran Type 4. 8.2.4.1

8.2.5   Instructions for Completing Tran Type 6. 8.2.5.1

8.2.6   Instructions for Completing Tran Type 7. 8.2.6.1

9.0 VeriFone Verification Response Section.. 9.0.1

9.1     Fields on MEVS receipt. 9.0.1

10.0 aCCEPTED REASON Codes. 10.0.1

11.0 reject Reason codes. 11.0.1

11.1   MEVS Terminal Message

12.0 Review Function.. 12.0.1

13.0 CODES SECTION.. 13.0.1

13.1   Co-payment Codes. 13.0.1

13.2   Taxonomy and Service Type Codes. 13.2.1

13.3   Out of State Providers. 13.3.1

13.4   County/District Codes. 13.4.1

13.5   Exception Codes. 13.5.1

13.6   Insurance Codes. 13.6.1

Insurance Coverage Codes. 13.6.1

13.7   New York City Office Codes. 13.7.1

Public Assistance. 13.7.1

Medical Assistance. 13.7.1

Special Services for Children (SSC) 13.7.2

Field Offices. 13.7.2

Office of Direct Child Care Services. 13.7.2

PCP Plan Codes. 13.7.2

14.0 DISPOSAL OF TRANZ 330 DEVICE.. 14.0.1

14.1   Instructions to clear memory.. 14.1.1

 


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

 

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 (2,000 or more transactions per month) providers.

 

·         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. 10/03)

 

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 Medicaid Management, Local District Support. The phone number for inquiries on TMA issues for clients residing Upstate is (518)-474-8216. For New York City client TMA issues, the number is (212) 268-6855.

 

 


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.

 

Access to the Telephone Verification System

 

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 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.

 

 


3.1       Telephone Equipment Specifications  (Rev. 11/02)

 

A regular touch-tone telephone is the only access to the Audio Response Unit (ARU). It can be identified by the push button dial and different tones when dialing or entering information into MEVS.

 

The telephone keypad has two keys with which you should become familiar:

 

     The *(asterisk) key is used to clear a mistake that you have made. Once the incorrect information is cleared, re-enter the correct information for that step.

 

Note: This key must be pressed before you press the # key.

 

The * (asterisk) key is also used to repeat the verification response.

 

     The # (pound) key separates information. It must be pressed after each piece of information is entered.

 

 


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. 10/03)

 

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.

 

  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 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 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 license type and license number. If entering a license number for New York State providers, after entering a license type, enter two zeros and the six-digit license number. If entering out of state license numbers, after entering the license type, 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 license type 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 license type, convert the alpha character to a number (see page 3.2.1) and enter that number followed by the actual license number.

Valid license types include:

                                In State         Out of State

Physician                      01                     11

Dentist                          02                     12

Physician’s Assistant     09                     19

Optometrist                   25                     35

Podiatrist                       26                     36

Audiologist                    27                     37

Nurse Practitioner          29                     39

Nurse Midwife                29                     39

Examples

MMIS Provider ID                    01234567

New York State License #       0100987654

Out of State License #             116251045678

Nurse Practitioner #                2933123456

NYS Optometrist #                  2582123456

Press # to bypass this prompt if you are not a dispensing provider.

NOTE:  When entering a license type 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: 2583000867 (License Type + 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.


3.4       Telephone Verification Response Section  (Rev. 10/03)

 

AN ELIGIBILITY SERVICE AUTHORIZATION RESPONSE THAT CONTAINS NO ERRORS WILL BE RETURNED IN THE FOLLOWING SEQUENCE.

 

Note:      Although all types of eligibility coverages are listed below, only one will be returned in the response.

 

MESSAGE SEQUENCE

RESPONSE

DESCRIPTION/COMMENTS

CIN

MEDICAID NUMBER AA22346D

The response begins with the client’s eight-digit Medicaid CIN.

COUNTY CODE

COUNTY CODE XX

The two-digit code which indicates the client’s county of fiscal responsibility.

Refer to Section 13.4 for county codes.

CLIENT’S MEDICAID COVERAGE

ELIGIBLE CAPITATION GUARANTEE

A response of “Eligible Capitation Guarantee” indicates guaranteed status under a Prepaid Capitation Program (PCP). The PCP provider is guaranteed the capitation rate for a period of time after a client becomes ineligible for Medicaid services. Clients enrolled in some PCPs are eligible for some fee-for-service benefits if referred by the PCP provider. To determine exactly what services are covered, contact the PCP designated in the insurance code field.

 

ELIGIBLE EXCEPT LONG TERM CARE

Client is eligible to receive all Medicaid services except nursing home services provided in an SNF or inpatient setting and/or waived services provided under the Long Term Health Care Program. All pharmacy, physician, ambulatory care services and inpatient hospital services, not provided in a nursing home, are covered.

 

ELIGIBLE ONLY FAMILY PLANNING SERVICES

A client who was pregnant within the past two years and was on Medicaid while pregnant is eligible for Medicaid covered family planning services for up to 26 months after the end date of pregnancy, regardless of whether the pregnancy ended in a miscarriage, live birth, still birth or an induced termination.

 

ELIGIBLE ONLY OUTPATIENT CARE

Client is eligible for all ambulatory care, including prosthetics; no inpatient coverage.

CLIENT’S MEDICAID COVERAGE (contd.)

ELIGIBLE PCP

A response of “Eligible PCP” indicates coverage under a Prepaid Capitation Program (PCP). This status means the client is PCP eligible as well as eligible for limited fee-for-service benefits. To determine exactly what services are covered, listen to the PCP services returned in the response. If further clarification is needed, contact the PCP designated in the insurance code field.

 

EMERGENCY SERVICES ONLY

Client is eligible for emergency services from the first treatment for the emergency medical condition until the condition requiring emergency care is no longer an emergency. An emergency is defined as a medical condition (including emergency labor and delivery) manifesting itself by acute symptom of sufficient severity (including severe pain), such that the absence of immediate medical attention could reasonably be expected to place the patient’s health in serious jeopardy, serious impairment of bodily functions or serious dysfunction of any body organ or part.

 

FAMILY HEALTH PLUS

Client is enrolled in the Family Health Plus Program (FHP) and receives all services through a FHP participating Managed Care Plan. The Medicaid program does not reimburse for any service that is excluded from the benefit package of the FHP Managed Care Plan.

 

MEDICAID ELIGIBLE HR UTILIZATION THRESHOLD

Client is eligible to receive all Medicaid services with prescribed limits for physician, psychiatric and medical clinic, laboratory, dental clinic and pharmacy services. A service authorization must be obtained.

 

MEDICAID ELIGIBLE

Client is eligible for all benefits.

 

MEDICARE COINSURANCE AND DEDUCTIBLE ONLY

Client is eligible for payment of Medicare coinsurance and deductible only. Deductible and coinsurance payments will be made for Medicare approved services only.

CLIENT’S MEDICAID COVERAGE (contd.)

PERINATAL FAMILY

Client is eligible to receive a limited package of benefits. The following services are excluded: podiatry, long- term home health care, long term care, hospice, ophthalmic services, DME, therapy (physical, speech, and occupational), abortion services, and alternate level care.

 

PRESUMPTIVE ELIGIBLE LONG-TERM/HOSPICE

Client is eligible for all Medicaid services except hospital based clinic services, hospital emergency room services, hospital inpatient services, and bed reservation.

 

PRESUMPTIVE ELIGIBILITY PRENATAL A

Client is eligible to receive all Medicaid services except inpatient care, institutional long-term care, alternate level care, and long-term home health care.

 

PRESUMPTIVE ELIGIBILITY PRENATAL B

Client is eligible to receive only ambulatory prenatal care services. The following services are excluded: inpatient hospital, long-term home health care, long-term care, hospice, alternate level care, ophthalmic, DME, therapy (physical, speech, and occupational), abortion, and podiatry.

ANNIVERSARY MONTH

ANNIVERSARY MONTH OCTOBER

This is the beginning month of the client’s benefit year.

CATEGORY OF ASSISTANCE

CATEGORY OF ASSISTANCE “S”

The code S signifies that the client is enrolled in the SSI assistance program.

MEDICARE DATA

Identifies the Medicare coverage for which the client is eligible, for the date of service entered.

MEDICARE PART A

A = Client has only Part A Medicare (inpatient hospital).

MEDICARE PART B

B = Client has only Part B Medicare (outpatient).

MEDICARE PARTS A and B

AB = Client has both Parts A and B Medicare Coverage.

MEDICARE PARTS A & B & QMB

ABQMB = Client has Part A and B Medicare coverage and is a Qualified Medicare Beneficiary (QMB).

MEDICARE PART A & QMB

AQMB = Client has Part A Medicare coverage and is a Qualified Medicare Beneficiary (QMB).

MEDICARE PART B & QMB

BQMB = Client has Part B Medicare coverage and is a Qualified Medicare Beneficiary (QMB).

MEDICARE QMB Only

QMB = Client is a Qualified Medicare Beneficiary (QMB) Only.

HEALTH INSURANCE CLAIM NUMBER XXXXXXXXXXXX

Actual Health Insurance Claim number consisting of up to twelve-digits. If a number is not available, the following message will be returned.

HEALTH INSURANCE CLAIM NUMBER NOT ON FILE

Actual Health Insurance Claim number is not on file.

THIRD PARTY INSURANCE AND COVERAGE CODES

INSURANCE COVERAGE CODE 21: DENTAL, PHYSICIAN, INPATIENT

Insurance and Coverage Codes equal the Insurance carrier and the scope of benefits. You will hear a two character insurance code and up to 13 coverage code descriptions. If you hear a third insurance code of ZZ call 1-800-343-9000 to obtain additional insurance and coverage information. Refer to your MMIS Provider Manual for insurance codes. Refer to Section 13.6, the Codes Section for the definitions/descriptions.

EXCEPTION RESTRICTION CODES

EXCEPTION CODE 35

If applicable, a client’s exception and/or restriction code will be returned. Refer to Section 13.5, the Exception Codes for the definitions/descriptions.

CO-PAY DATA

NO CO-PAYMENT REQUIRED

This message will be heard if the client is under 21 or exempt from co-payment and co-payment data has been entered.

 

CO-PAYMENT REQUIREMENTS MET ON MM/DD/YY

Client has reached his/her co-payment maximum. The date equals the date of inquiry, which brought the co-payment over the maximum. You should not collect the co-payment until the next co-payment period.

UTILIZATION THRESHOLD POST AND CLEAR DATA

AT SERVICE LIMIT

The client has reached his/her limit for that particular service category. No service authorization is created. The service is not approved and payment by Medicaid will not be made. Refer to your MMIS manual if the patient has either an emergency or medically urgent situation.

 

DUPLICATE - UT PREVIOUSLY APPROVED

The service authorization request is a duplicate of a previously approved service authorization request for a given provider, client, and date of service.

 

PARTIAL APPROVAL XX SERVICE UNIT(S) POST AND CLEAR

Indicates that the full complement of requested services relative to Post and Clear processing is not available. The XX represents the number of services approved/available.

 

PARTIAL APPROVAL XX SERVICE UNIT(S), XX LAB UNIT(S), XX PHARMACY UNIT(S) UTILIZATION THRESHOLD

Indicates that the full complement of requested services relative to Utilization Threshold processing is not available. The XX represents the number of services approved/available.

 

SERVICE APPROVED NEAR LIMIT XX SERVICE UNIT(S), XX LAB UNIT(S), XX PHARMACY UNIT(S)

The service authorization has been granted and recorded. The client has almost reached his/her service limit. For the convenience of the provider and the client, this message also indicates that the patient is using services at a rate that could exhaust his/her limit for that particular service category.

 

SERVICE APPROVED UTILIZATION THRESHOLD XX SERVICE UNIT(S), XX LAB UNIT(S), XX PHARMACY UNIT(S)

The service units requested are approved, as the client has not utilized his/her UT limit. A service authorization will be created.

 

SERVICES APPROVED POST AND CLEAR XX SERVICE UNIT(S), XX LAB UNIT(S), XX PHARMACY UNIT(S)

The ordering provider has posted services and those service units have been approved. This message will also be returned for all providers who are designated card swipers, except pharmacy, for Tran Type 1 entry.

DATE OF SERVICE

FOR DATE MMDDYY

This will be heard when the message is complete and reflects the date for which services were requested. You can repeat the message one time by pressing the * key.

 

Note:      You will be allowed to perform a maximum of three transactions during a single call. If less than three transactions have been completed, you will automatically be prompted for another transaction. If no other transactions are needed, disconnect your call.

 


3.5       Telephone Verification Error and Denial Responses  (Rev. 10/03)

 

The next few pages contain processing error and denial messages that may be heard. Error responses are heard immediately after an incorrect or invalid entry. To change the entry, enter the correct data and press the # key. Denial responses are heard when the transaction is rejected due to the type of invalid data entered. The entire transaction must be reentered.

 

RESPONSE

DESCRIPTION/COMMENTS

CALL 800-343-9000

When certain conditions are met (ex: multiple responses), you are instructed to call the Provider Services staff for additional data.

DECEASED ORDERING PROVIDER

The License Number or eight-digit MMIS Provider ID that was entered in the ordering provider field is in a deceased status on the Master file and cannot prescribe. Check the number entered. If a license number was entered, make sure the correct license type/license number combination and format was entered.

DISQUALIFIED ORDERING PROVIDER

The License Number or eight-digit MMIS Provider ID that was entered in the ordering provider field is in a disqualified status on the Master file and cannot prescribe. Check the number entered. If a license number was entered, make sure the correct license type/license number combination and format was entered.

EXCESSIVE ERRORS, REFER TO MEVS MANUAL OR CALL 800-343-9000 FOR ASSISTANCE

Too many invalid entries have been made during the transaction. Refer to Section 3.3 for the input data section, or call 800-343-9000.

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.

For example: a Pharmacy can submit an eligibility transaction via the telephone but cannot submit a Service Authorization Transaction unless exempt from the ProDUR Program.

INVALID ACCESS NUMBER

An invalid access number was entered. Check the number and retry the transaction.

INVALID CARD THIS RECIPIENT

Client has used an invalid card. Check the number you have entered against the client’s Common Benefit Identification Card. If they agree, the client has been issued a new and different Benefit Identification Card and must produce the new card prior to receiving services.

INVALID CO-PAYMENT

This message is heard at the prompt if the data entered is not in the correct format (invalid number of digits or number doesn't covert to an alpha character). Receiving this message will prohibit the next prompt from being spoken. To proceed, re-enter the data in the correct format.

INVALID CO-PAYMENT, REFER TO MEVS MANUAL

The Data entered is not a valid co-payment value. Refer to Section 13.0 for Codes Section.

INVALID DATE

An illogical date or a date which falls outside of the allowed MEVS inquiry period was entered. The allowed period is 24 months retroactive from the entry date.

INVALID ENTRY

An invalid number of digits was entered for service units. Service units must be one or two-digits.

INVALID IDENTIFICATION NUMBER

The client identification number entered was an incorrect length, or an invalid alpha converted number was entered.

INVALID LICENSE TYPE

The License Type entered in the ordering provider field is not a valid value. Refer to the values listed in the ordering provider field in Section 3.3 of this manual.

INVALID MEDICAID NUMBER

An invalid CIN was entered. Refer to the alpha conversion chart in the beginning of this manual. Verify that the CIN was correctly converted to an eleven-digit number.

INVALID MENU OPTION

An invalid entry was made when selecting the identifier type. The entry must be 1 (alphanumeric identifier) or 2 (numeric identifier).

INVALID ORDERING PROVIDER NUMBER

The license number or MMIS Provider ID number that was entered in the ordering provider field was not found on the license or provider files.

INVALID PROVIDER NUMBER

The provider number entered is an invalid eight-digit number.

INVALID REFERRING PROVIDER NUMBER

The referring provider ID number was entered incorrectly or is not a valid MMIS Provider ID number. A license number cannot be entered in this field.

INVALID SEQUENCE NUMBER

The sequence number entered is not valid or not current. Check the client’s card for the current sequence number.

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 AUTHORIZATION

Services must be provided, ordered, or referred by the primary provider. Enter the MMIS Provider ID of the primary provider to whom the client is restricted.

NO COVERAGE EXCESS INCOME

Client has income in excess of the allowable levels. All other eligibility requirements have been satisfied. This individual will be considered eligible for Medicaid reimbursable services only at the point his or her excess income is reduced to the appropriate level. The individual may reduce his or her excess income by paying the amount of the excess to the Local Department of Social Services, or by submitting bills for the medical services that are at least equal to the amount of the excess income. Medical services received prior to meeting the excess income amount can be used to reduce the amount of the excess.

NO COVERAGE PENDING FAMILY HEALTH PLUS

Client is waiting to be enrolled into a Family Health Plus Managed Care Plan. No Medicaid services are reimbursable.

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 requested. Contact the client’s Local Department of Social Services for eligibility discrepancies.

PRESCRIBING PROVIDER LICENSE NOT IN ACTIVE STATUS

The license number entered in the ordering provider field is on the license file but is not active for the date of service entered.

PROVIDER INELIGIBLE FOR SERVICE ON DATE PERFORMED

The Category of Service for the Provider number submitted in the transaction is inactive or invalid for the entered Date of Service. This message will also be returned if Specialty Codes 760 (Clinic Pharmacy) or 307 (DME) are entered in the transaction and the associated Category of Service is not on file or is invalid for the entered Date of Service.

PROVIDER NOT ELIGIBLE

The verification was attempted by an inactivated or disqualified provider.

PROVIDER NOT ON FILE

The provider number entered is not identified as a Medicaid enrolled provider. Either the number is incorrect or not on the provider master file.

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 NUMBER

The license number or provider number entered in the ordering provider field has the incorrect format (wrong length or characters in the wrong position).

RESTRICTED RECIPIENT NO AUTHORIZATION

This client is restricted to services from a specific provider. Enter the MMIS Provider ID to whom the client is restricted.

SERVICES NOT ORDERED

The ordering provider did not post the services you are trying to clear. Contact the ordering provider.

SSN ACCESS NOT ALLOWED

The provider is not authorized to access the system using a social security number. The Medicaid Number (CIN) or Access Number must be entered.

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 UNAVAILABLE. PLEASE CALL 800-343-9000 FOR ASSISTANCE.

The system is currently unavailable.

After this message is voiced, you will be disconnected.

 

 

 

 


4.0        INTRODUCTION TO THE Verifone Omni 3750 MEVS Terminal  (Rev. 10/03)

 

The VeriFone terminal is designed to provide an accurate and timely verification of a client’s eligibility for Medicaid services. Specific features and conveniences, such as a large LCD screen, ATM style buttons and a built in printer, make the verification process easy to learn and use with a minimum of training time.

 

Multiple provider identification numbers can be programmed into the VeriFone terminal in the Provider Menu. When programmed, the two-digit shortcut code assigned to that Provider can be selected, instead of entering the full eight-digit Provider ID number. Refer to Section 7.3 for Instructions to Provider Menu or call 1-800-343-9000 for assistance in adding multiple provider numbers to your terminal.

 

The Quick Start (Refer to Section 5.0) is a quick and easy way to install the VeriFone Omni 3750 terminal. For step-by-step instructions use the VeriFone Installation Instructions (Refer to Section 7.0).

 

Initial Screen

 

When the VeriFone Omni 3750 terminal is not actively being used, the device normally shows its “initial screen” (see below). This screen is referenced often in this manual. To get to this screen in most circumstances, press the red cancel key.

 

Initial screen example:

 

 

FRI 9/5 9-13A

 

EMEDNY

 

SWIPE CARD OR

PRESS F4 TO BEGIN

 

Vxxxx

 

 

The “xxxx” in “Vxxxx” on the bottom line is the software version the terminal is using. This number may be needed when calling provider services for assistance.

 

 


5.0        Quick Start  (Rev. 10/03)

 

The Quick Start is an easy way to setup up the VeriFone Omni 3750 terminal. For a full and detailed description of the terminal refer to Section 6.0 VeriFone Omni 3750 Terminal.

 

1.      Select a location that has access to a power outlet and a telephone line for your terminal. Open the box and unpack the terminal. (Refer to Section 7.0 VeriFone Installation Instructions for step-by-step instructions).

 

2.      Connect the telephone line cord into the telephone jack labeled ‘H S’. Connect the other end into the wall jack. (Refer to Section 6.2. VeriFone Omni 3750 Terminal – Back).

 

3.      Connect the power connector into the power port on the back of the terminal, and the power cord into the power pack. Plug the three-prong power cord into the power outlet. (Refer to Section 6.2. VeriFone Omni 3750 Terminal – Back).

 

4.      After the device has gone through its start-up routine, the day, date, and time is displayed on the top line of the terminal.

 

Note: The terminal uses it’s internal clock to calculate the date that will be entered on your transaction. Please ensure that the Day, Date and Time are correct. For instructions on resetting Day, Date and Time, please refer to Section 7.1.

 

5.      The terminal will arrive with the requestor’s Provider number pre-programmed. It is recommended to review the Medicaid Provider number before using the terminal. Press the P2 key (labeled “Provider”) to enter the Provider Menu. “Provider Setup” is briefly displayed. When the Password prompt is displayed, enter the following six-digit number ‘123456’ and press the ENTER key. When the terminal displays “ENTER PROVIDER NUMBER”, enter the two-digit number ‘01’ and press the ENTER key. “PROVIDER NUMBER 01” is displayed with the pre-programmed Provider number below the text.

 

6.      To use the pre-programmed Provider number, press the CANCEL/CLEAR key, to return to the initial screen. To change the pre-programmed Provider number, press the BACKSPACE key eight times to clear the number. Then enter the eight-digit Medicaid Provider number and press the ENTER key. If you have no additional Provider numbers to enter, press the CANCEL/CLEAR key. To store additional Provider numbers refer to Section 7.3 for Instructions to Provider Menu.

 

7.      If you are required to dial a number to get an outside line (e.g. ‘9’), press the P1 key (labeled “Setup”) to enter the Setup Menu. When the Password prompt is displayed, enter the following six-digit number ‘123456’ and press the ENTER key. The “DIAL PREFIX” is displayed, enter the access code (e.g. single digit “9”) and press the ENTER key. After the access code has been entered, press the CANCEL/CLEAR key to return to the Initial Screen. (Refer to Section 7.2 for Instructions on Setup Menu).

 

8.      Press the F4 key or swipe the CBIC card in the Magnetic Card Reader to begin processing transactions to eMedNY.

 


6.0        VeriFone Omni 3750 Terminal  (Rev. 10/03)

 

The VeriFone Omni 3750 terminal is a verification device that uses basic telephone outlets to connect with Medicaid Eligibility Verification System (MEVS).

 

6.1       VeriFone Omni 3750 Terminal - Front

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


6.1.1      VeriFone Omni 3750 Terminal Description - Front

 

A.

INTERNAL THERMAL PRINTER

A dot matrix printer in which heat is applied to the pins of the matrix to form dots on heat-sensitive paper.

B.

Indicator LED

Power and Paper Indicator.

NOTE: A blinking light indicates to check paper supply or paper is not inserted properly.

C.

Paper Cover Release

Open the printer paper compartment.

D.

f4 ATM-STYLE FUNCTION

Key

Starts a verification transaction through entry of the access number or Medicaid Number (CIN).

E.

LCD Screen

The verification response and system messages will be displayed in this area.

F.

Magnetic Card Reader

Slot that reads the magnetic stripe on the back of the card. This allows for quicker entry of verification transactions.

G.

ALPHA Key

Converts numeric digits to alphabetic letters.

H.

PAPER ADVANCE Key

Press the 3 Key from the initial screen to advance the paper one line at a time.

I.

TELEPHONE STYLE KEYPAD

Area where user enters data needed for the Medicaid verification.

J.

ENTER KEY

Inputs new data into the system.

K.

BACKSPACE KEY

Erases the last numeric digit or alphabetic letter entered.

L.

CANCEL/CLEAR Key

Erases all previously entered data and returns to the ready mode.

M.

reprint key

From the initial screen, prints a duplicate copy of the verification message.

N.

P1 SETUP Key

Allows modification of the Terminal Settings. (Refer to Section 7.2 for Instructions for Setup Menu)

O.

P2 Provider Key

Allows for add, update, delete, and review of multiple provider Ids. (Refer to Section 7.3 for Instructions for Provider Menu)

P.

P3 Scroll Back Key

Facilitates scrolling to the previous line, if applicable.

Q.

P4 Scroll Forward/REVIEW Key

Facilitates scrolling to the next line, if applicable. Also is used to review the previous transaction. (Refer to Section 12.0 for Review Function)



 

6.2       VeriFone Omni 3750 Terminal – Back

 


 


Telephone Line Cord

 


 


Power Pack


 



7.0        VERIFONE INSTALLATION INSTRUCTIONS  (Rev. 10/03)

 

These instructions will assist with the setup of the VeriFone Omni 3750 terminal. Select a location that has access to a power outlet and a telephone line for your terminal.

 

Connecting the Telephone Line

 

1.            Connect one end of the telephone line cord to the telephone jack labeled “H S” on the right hand side at the rear of the terminal

 

2.            Connect the other end of the telephone line cord to your RJ11-type modular telephone wall jack. If you do not have a telephone wall jack, obtain an adapter from your local telephone company.

 

Connecting the Terminal Power Pack

 

1.            Connect the power connector into the power port.

 

2.            To lock the power connector, align the plastic lock tab pointing up and turn to the left. To unlock the power connector, turn to the right.

 

3.            Connect the power cord into the power pack.

 

4.            Plug the three-prong AC power cord into an indoor 120-volt AC outlet.

 

WARNING: Do not plug the power pack into an outdoor outlet or operate the terminal outdoors.

 

Inserting Thermal Paper into the Internal Thermal Printer

 

1.            To open the printer paper compartment, press the Paper Cover Release button located on the right side of the terminal.

 

2.            Insert a roll of thermal paper, and ensure paper feeds from underneath. (See illustration 2b of the Quick Instruction Guide provided with the new device).

 

3.            Press down to close the printer paper compartment.

 

Ordering Thermal Paper for the Internal Thermal Printer

 

To order additional thermal paper (2.25 Inches by 85 Feet thermal paper), contact TASQ Technology at 1-800-420-3197 or your nearest office supply store.

 

 


7.1       Instructions to Reset Day/Date/Time

 

To set or reset the day, date, and time follow the Display/Action table.

 

DISPLAY

ACTION

The Initial Screen is displayed.

Press the F2 and F4 key at the same time

SYSTEM MODE ENTRY PASSWORD

Enter “Z66831” (1-alpha-alpha 66831) and press the ENTER key

SYS MODE MENU 1

Press the F3 key for CLOCK

SYS MODE CLOCK

YEAR: YYYY

MONTH: MM

DAY: DD

Enter the current date as “CCYYMMDD

 

Press the P2 key labeled Provider.

SYS MODE CLOCK

HOUR: HH

MINUTE: MM

Enter Time as “HHMM

Enter HH in 24-Hour clock format

(e.g. 1:00 p.m.

HOUR: 13

MINUTE: 00)

Press the ENTER key to Save and Exit

SYS MODE MENU 1

Press the F4 key to restart the device

Initial screen

 

 

 


7.2       Instructions for Setup Menu (P1 Key)

 

Access this menu by pressing the P1 key labeled as the Setup Menu. This menu allows the user to modify several variables that the device uses. To edit the Setup Menu follow the Display/Description/Action table.

 

Press the CANCEL/CLEAR key to return to the initial screen.

 

DISPLAY

DESCRIPTION

ACTION

Initial Screen

 

Press the P1 key to enter the Setup Menu

Terminal Setup

ENTER PASSWORD

 

Enter the following six-digit number ‘123456’ and press the ENTER key.

DIAL PREFIX

##

-----------------

The Dial Prefix is dialed before the telephone number.

If a value has already been entered, it will display on the second line (“##”).

If you are required to dial a number (e.g. ‘9’) to get an outside line, enter the access code here (e.g. single digit “9”) and press the ENTER key.

After the access code has been entered, press the CANCEL/CLEAR key.

ENTER NYM TELE #

1-866-828-4814

------------------------

This is the number the device will dial to submit transactions.

Press the ENTER key to continue.

If you need to change this number, call the Provider Help Desk at

1-800-343-9000.

   ENTER BACKUP #

1-866-828-4815

------------------------

This is the number the device will dial in case the main number does respond.

Press the ENTER key to continue.

If you need to change this number, call the Provider Help Desk at

1-800-343-9000.

DIAL TYPE

TONE

TONE

PULSE

The type of phone system used. Touchtone is most commonly used. Default is ‘Tone’.

The current setting is the word under “DIAL TYPE”. If you need to change the setting, press the F1 key for Tone or press the F2 key for Pulse. Otherwise, press the ENTER key to continue.

PRINT ALL

YES

YES

NO

This designates whether the device will automatically print responses. Default is ‘YES’.

The current setting is the word under “PRINT ALL”. To change the setting, press the F1 key to automatically print responses or press the F2 key to not automatically print responses.

NOTE: When the “PRINT ALL” is set to “no”, you may print manually by pressing the asterisk “*” key from the initial screen.

Press the ENTER key to continue.

KEY BEEP

NO

YES

NO

This designates whether the device will beep when a key is pressed. Default is ‘NO’.

The current setting is the word under “KEY BEEP”. To change the setting, press the F1 key to beep or press the F2 key to not beep.

NOTE: Errors will still cause a beep to sound.

Press the ENTER key to continue.

DOWNLOAD TELE #

1-888-843-7160

---------------------

This is the phone number the device will dial to download a new application to the device.

 Press the ENTER key to continue.

If you need to change this number, call the Provider Help Desk at 1-800-343-9000.

ENTER NEW PASSWORD

  -------

This is the password used to access the Setup Menu and the Provider Menu.

WARNING:

If you need to have a different password, enter it here. Be advised that if you change it, Provider Services will not be able to reset it for you. Press the ENTER key to return to the initial screen without changing the password.

 

 


7.3       Instructions for Provider Menu (P2 key)

 

Access this menu by pressing the P2 key labeled as the Provider Menu. The VeriFone Omni 3750 terminal can store up to 20 MMIS Provider ID numbers to quickly process transactions. Each Provider number can be used by entering the two-digit shortcut code that corresponds to the Provider submitting the transaction. To store additional Provider numbers in the terminal follow the Step/Action/Display table.

 

Press the CANCEL/CLEAR key to return to the initial screen.

 

NOTE:   If only one MMIS Provider ID is entered in the table, it will automatically be used for each transaction and the prompt “Select Provider” will not be displayed.

 

 

DISPLAY

ACTION

Initial Screen

Press the P2 key to enter the Provider Menu

ENTER PASSWORD

Enter the following six-digit number ‘123456’ and press the ENTER key

Provider Setup is displayed

 

ENTER PROVIDER NUMBER

--

Enter a valid two-digit number (01 – 20). The first shortcut assigned must start with 01.

NOTE: It is important to keep track of the shortcuts that correspond with each Provider ID.

PROVIDER NUMBER nn

########

 

The ‘nn’ on the first line is the two-digit shortcut number corresponding to the Provider.

The “########” on the second line is the eight-digit MMIS Provider ID.

If a provider number is not associated with ‘nn’, then a blank line will display instead of the Provider number.

Enter the eight-digit MMIS Provider ID that you are assigning to that shortcut and press the ENTER key

To change the number currently displayed press the BACKSPACE key to clear the existing Provider number, enter the new number and press the ENTER key

OR

Press the ENTER key to keep the current value

 

ENTER PROVIDER NUMBER

--

Press the CANCEL/CLEAR key to return to the Initial Screen

OR

Repeat Steps 2 through 4 to store additional Providers


8.0        VeriFone Verification Input Section  (Rev. 10/03)

8.1       VeriFone Verification Using the Access Number or Medicaid Number (CIN)

 

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 using the Access Number by swiping the card through the terminal. The Medicaid number (CIN) is an eight-character alpha/numeric identifier on the Common Benefit Identification Card.

 

8.2       Instructions for Completing a VeriFone Transaction

 

     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, refer to Section 7.3 for Instructions to Provider Menu or call 1-800-343-9000. (Please maintain a listing of provider numbers and corresponding shortcuts.)

 

     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.

 

 


8.2.1      Instructions for Completing Tran Type 1

Note:      Laboratories and Pharmacies should not use Tran Type 1. Please refer to Section 8.2.6 for Tran Type 7.

Service Authorization and Eligibility Inquiry: This transaction must be used to obtain a service authorization for Post and Clear (PC) and Utilization Threshold (UT) programs. Co-payment entries will be determined based on the entry in the SERVICE TYPE and/or TAXONOMY and the # Service Units prompts.

 

 

 

PROMPT DISPLAYED

ACTION/INPUT

 

TO BEGIN:

Press the CANCEL/CLEAR key.

Press the F4 key or swipe the CBIC card in the Magnetic Card Reader to start the verification.

ENTER CARD OR ID

If you are using the client access number, swipe the card through the reader or key the access number and press the ENTER key.

To use the card, smoothly swipe it through the magnetic stripe reader from top to bottom. “NY Access #” will be displayed for one second.

Note: The access number must be entered manually if using a replacement paper Benefit Identification Card or if using a plastic card with a damaged magnetic stripe. The six-digit ISO number on the Benefit Identification Card does not need to be entered when manually entering the access number.

If you are using the Client Medicaid number (CIN), enter the Medicaid number and press the ENTER key. The type of identification used will be displayed for one second.

ENTER TRAN TYPE

1    Service Authorization and Eligibility Inquiry: This transaction must be used to obtain a service authorization for Post and Clear (PC) and Utilization Threshold (UT) programs.

 

Press the ENTER key.

ENTER SEQ #

If your Identification Number entry was a Medicaid ID number (CIN), enter the two-digit sequence number and press the ENTER key. The sequence number is the last two-digits of the access number.

If the Access Number was entered, this prompt will not display.

ENTER DATE

Press the ENTER key for today's date. If you are doing a transaction for a previous date of service, you must enter the eight-digit date, MMDDCCYY, and press the ENTER key.

For all inpatient co-payment entries, the date should equal the discharge date.

SELECT PROVIDER

If you see this prompt, there are multiple provider numbers programmed into this terminal. Enter the appropriate shortcut code associated with your provider Identification Number or enter an eight-digit MMIS Provider ID and press the ENTER key (To add numbers call 1-800-343-9000).

ENTER TAXONOMY

This code is used for classifying health care providers according to provider type or practitioner specialty. (Refer to Section 13.2 for Taxonomy Codes).

Press the ENTER key to bypass if not required.

SERVICE TYPE

Enter the code identifying the type of service you are providing. (Refer to Section 13.2 for Service Type Codes).

Press the ENTER key to bypass if not required.

ORDERING PRV #

Enter the MMIS Provider ID number of the ordering provider and press the ENTER key. 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 license type and license number. If entering a license number for New York State providers, first enter a license type, followed by two zeros, then the six-digit license number. If entering out of state license numbers, first enter the license type, followed by the two-digit alpha character state code then the six-digit license number. NYS Nurse Practitioners who are allowed to prescribe will have an F preceding their license number. NYS Optometrists who are allowed to prescribe will have an alpha character (U or V) preceding their license number. When entering their license number, enter the license type followed by a zero, the alpha character and the six-digit license number.

 

Valid license types include:

 

                                In State         Out of State

 

Physician                      01                     11

Dentist                          02                     12

Physician’s Assistant     09                     19

Optometrist                   25                     35

Podiatrist                       26                     36

Audiologist                    27                     37

Nurse Practitioner          29                     39

Nurse Midwife                29                     39

 

Examples:

 

MMIS Provider ID                    01234567

New York State License #       0100987654

Out of State License #             11NJ345678

Nurse Practitioner #                290F121212

NYS Optometrist #                  250U452749

 

NOTE: When entering a license type 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: 250U000867 (License Type + 0U + Zero fill + License Number).

REFERRING PRV #

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 the ENTER key. 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 Medicaid ID number in response to this prompt.

 

If the client is not restricted or in MCCP, press the ENTER key to bypass this prompt.

NOTE:   The system will default the copay type based on the entry of the Service Type and/or Taxonomy.

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 and press the ENTER key.

NOTE:   If you are a POST and CLEAR Provider, enter the appropriate data for the following two prompts. Bypass by pressing the ENTER key.

# LAB TESTS

Enter the number of lab tests you are ordering and press the ENTER key. If no lab tests are required, bypass by pressing the ENTER key.

# RX/OTC

Enter the number of prescriptions or over the counter items you are ordering and press the ENTER key. If no RX/OTC are required, bypass by pressing the ENTER key.

THIS ENDS THE INPUT DATA SECTION. The VeriFone will now dial into the MEVS system and display these processing messages:

DIALING, WAITING FOR ANSR, CONNECT XXXX, WAITING FOR ENQ, TRANSMITTING, and RECEIVING.

These processing messages are displayed.

 

 


8.2.2      Instructions for Completing Tran Type 2

 

Eligibility Inquiry only: This transaction may also be used to determine if a client is at limit for the service category you are providing or ordering under the UT program.

 

PROMPT DISPLAYED

ACTION/INPUT

 

TO BEGIN:

Press the CANCEL/CLEAR key.

Press the F4 key or swipe the CBIC card in the Magnetic Card Reader to start the verification.

ENTER CARD OR ID

If you are using the client access number, swipe the card through the reader or key the access number and press the ENTER key.

To use the card, smoothly swipe it through the magnetic stripe reader from top to bottom. “NY Access #” will be displayed for one second.

Note: The access number must be entered manually if using a replacement paper Benefit Identification Card or if using a plastic card with a damaged magnetic stripe. The six-digit ISO number on the Benefit Identification Card does not need to be entered when manually entering the access number.

If you are using the Client Medicaid number (CIN), enter the Medicaid number and press the ENTER key. The type of identification used will be displayed for one second.

ENTER TRAN TYPE

2         Eligibility Inquiry only: This transaction may also be used to determine if a client is at limit for the service category you are providing or ordering under the UT program.

Press the ENTER key.

ENTER SEQ #

If your Identification Number entry was a Medicaid ID number (CIN), enter the two-digit sequence number and press the ENTER key. The sequence number is the last two-digits of the access number.

If the Access Number was entered, this prompt will not display.

ENTER DATE

Press the ENTER key for today's date. If you are doing a transaction for a previous date of service, you must enter the eight-digit date, MMDDCCYY, and press the ENTER key.

SELECT PROVIDER

If you see this prompt, there are multiple provider numbers programmed into this terminal. Enter the appropriate shortcut code associated with your provider Identification Number or enter an eight-digit MMIS Provider ID and press the ENTER key (To add numbers call 1-800-343-9000).

ENTER TAXONOMY

This code is used for classifying health care providers according to provider type or practitioner specialty. (Refer to Section 13.2 for Taxonomy Codes).

Press the ENTER key to bypass if not required.

SERVICE TYPE

Enter the code identifying the type of service you are providing. (Refer to Section 13.2 for Service Type Codes)

Press the ENTER key to bypass if not required.

ORDERING PRV #

Enter the MMIS Provider ID number of the ordering provider and press the ENTER key. 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 license type and license number. If entering a license number for New York State providers, first enter a license type, followed by two zeros, then the six-digit license number. If entering out of state license numbers, first enter the license type, followed by the two-digit alpha character state code then the six-digit license number. NYS Nurse Practitioners who are allowed to prescribe will have an F preceding their license number. NYS Optometrists who are allowed to prescribe will have an alpha character (U or V) preceding their license number. When entering their license number, enter the license type followed by a zero, the alpha character and the six-digit license number.

 

Valid license types include:

 

                                In State         Out of State

 

Physician                      01                     11

Dentist                          02                     12

Physician’s Assistant     09                     19

Optometrist                   25                     35

Podiatrist                       26                     36

Audiologist                    27                     37

Nurse Practitioner          29                     39

Nurse Midwife                29                     39

 

 

Examples:

 

MMIS Provider ID                    01234567

New York State License #       0100987654

Out of State License #             11NJ345678

Nurse Practitioner #                290F121212

NYS Optometrist #                  250U452749

 

NOTE: When entering a license type 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: 250U000867 (License Type + 0U + Zero fill + License Number).

NOTE:     The Referring Provider # prompt will be displayed only if the prompt for the Ordering Provider is bypassed.

REFERRING PRV #

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 the ENTER key. 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 Medicaid ID number in response to this prompt.

 

If the client is not restricted or in MCCP, press the ENTER key to bypass this prompt.

THIS ENDS THE INPUT DATA SECTION. The VeriFone will now dial into the MEVS system and display these processing messages:

DIALING, WAITING FOR ANSR, CONNECT XXXX, WAITING FOR ENQ, TRANSMITTING, and RECEIVING.

These processing messages are displayed.

 

 


8.2.3      Instructions for Completing Tran Type 3

 

Authorization Confirmation: This transaction is used to determine if an authorization has already been requested for this client, for a particular date of service. To be used with Medicaid Number (CIN) ONLY.

 

PROMPT DISPLAYED

ACTION/INPUT

 

TO BEGIN:

Press the CANCEL/CLEAR key.

Press the F4 key or swipe the CBIC card in the Magnetic Card Reader to start the verification.

ENTER CARD OR ID

Enter the Medicaid number (CIN) and press the ENTER key. The type of identification used will be displayed for one second.

ENTER TRAN TYPE

3         Authorization Confirmation: This transaction is used to determine if an authorization has already been requested for this client, for a particular date of service. To be used with Medicaid Number (CIN) ONLY.

 

Press the ENTER key.

ENTER SEQ #

Enter the two-digit sequence number and press the ENTER key. The sequence number is the last two-digits of the access number.

ENTER DATE

Press the ENTER key for today's date. If you are doing a transaction for a previous date of service, you must enter the eight-digit date, MMDDCCYY, and press the ENTER key.

SELECT PROVIDER

If you see this prompt, there are multiple provider numbers programmed into this terminal. Enter the appropriate shortcut code associated with your provider Identification Number or enter an eight-digit MMIS Provider ID and press the ENTER key (To add numbers call 1-800-343-9000).

ENTER TAXONOMY

This code is used for classifying health care providers according to provider type or practitioner specialty. (Refer to Section 13.2 for Taxonomy Codes).

Press the ENTER key to bypass if not required.

SERVICE TYPE

Enter the code identifying the type of service you are providing. (Refer to Section 13.2 for Service Type Codes)

Press the ENTER key to bypass if not required.

# SERVICE UNITS

Enter the total number of service units and press the ENTER key.

# LAB TESTS

Enter the number of lab tests and press the ENTER key. If no lab tests are required, bypass by pressing the ENTER key.

# RX/OTC

Enter the number of prescriptions or over the counter items and press the ENTER key. If no RX/OTC are required, bypass by pressing the ENTER key.

THIS ENDS THE INPUT DATA SECTION. The VeriFone will now dial into the MEVS system and display these processing messages:

DIALING, WAITING FOR ANSR, CONNECT XXXX, WAITING FOR ENQ, TRANSMITTING, and RECEIVING.

These processing messages are displayed.

 


8.2.4      Instructions for Completing Tran Type 4

 

Authorization Cancellation: This transaction is used to cancel an authorization. Use Medicaid Number (CIN) ONLY. Must be done within 24 hours of the authorization you are canceling.

 

PROMPT DISPLAYED

ACTION/INPUT

 

TO BEGIN:

Press the CANCEL/CLEAR key.

Press the F4 key or swipe the CBIC card in the Magnetic Card Reader to start the verification.

ENTER CARD OR ID

Enter the Medicaid number and press the ENTER key. The type of identification used will be displayed for one second.

ENTER TRAN TYPE

4         Authorization Cancellation: This transaction is used to cancel an authorization. Use Medicaid Number (CIN) ONLY. Must be done within 24 hours of the authorization you are canceling.

 

Press the ENTER key.

ENTER SEQ #

Enter the two-digit sequence number and press the ENTER key. The sequence number is the last two-digits of the access number.

ENTER DATE

Press the ENTER key for today's date. If you are doing a transaction for a previous date of service, you must enter the eight-digit date, MMDDCCYY, and press the ENTER key.

SELECT PROVIDER

If you see this prompt, there are multiple provider numbers programmed into this terminal. Enter the appropriate shortcut code associated with your provider Identification Number or enter an eight-digit MMIS Provider ID and press the ENTER key (To add numbers call 1-800-343-9000).

ENTER TAXONOMY

This code is used for classifying health care providers according to provider type or practitioner specialty. (Refer to Section 13.2 for Taxonomy Codes).

Press the ENTER key to bypass if not required.

SERVICE TYPE

Enter the code identifying the type of service you are providing. (Refer to Section 13.2 for Service Type Codes).

Press the ENTER key to bypass if not required.

# SERVICE UNITS

Enter the total number of service units and press the ENTER key.

# LAB TESTS

Enter the number of lab tests you are canceling and press the ENTER key. If no lab tests are required, bypass by pressing the ENTER key.

# RX/OTC

Enter the number of prescriptions or over the counter items you are canceling and press the ENTER key. If no RX/OTC are required, bypass by pressing the ENTER key.

THIS ENDS THE INPUT DATA SECTION. The VeriFone will now dial into the MEVS system and display these processing messages:

DIALING, WAITING FOR ANSR, CONNECT XXXX, WAITING FOR ENQ, TRANSMITTING, and RECEIVING.

These processing messages are displayed.

 

 


8.2.5      Instructions for Completing Tran Type 6

 

Dispensing Validation System (DVS) Request: This transaction allows suppliers of prescription footwear items, certain medical surgical supplies and equipment to request a DVS number (Prior approval). This transaction code is also used to obtain Dental DVS Numbers.

 

PROMPT DISPLAYED

ACTION/INPUT

 

TO BEGIN:

Press the CANCEL/CLEAR key.

Press the F4 key or swipe the CBIC card in the Magnetic Card Reader to start the verification.

ENTER CARD OR ID

If you are using the client access number, swipe the card through the reader or key the access number and press the ENTER key.

To use the card, smoothly swipe it through the magnetic stripe reader from top to bottom. “NY Access #” will be displayed for one second.

Note: The access number must be entered manually if using a replacement paper Benefit Identification Card or if using a plastic card with a damaged magnetic stripe. The six-digit ISO number on the Benefit Identification Card does not need to be entered when manually entering the access number.

If you are using the Client Medicaid number (CIN), enter the Medicaid number and press the ENTER key. The type of identification used will be displayed for one second.

ENTER TRAN TYPE

6    Dispensing Validation System (DVS) Request: This transaction allows suppliers of prescription footwear items, certain medical surgical supplies and equipment to request a DVS number (Prior Approval). This transaction code is also used to obtain Dental DVS Numbers for selected Dental Procedure Codes.

 

Press the ENTER key.

ENTER SEQ #

Enter the two-digit sequence number and press the ENTER key. The sequence number is the last two-digits of the access number.

If the Access Number was entered, this prompt will not display.

ENTER DATE

Press the ENTER key for today's date. DVS transactions require a current date entry.

SELECT PROVIDER

If you see this prompt, there are multiple provider numbers programmed into this terminal. Enter the appropriate shortcut code associated with your provider Identification Number or enter an eight-digit MMIS Provider ID and press the ENTER key (To add numbers call 1-800-343-9000).

ENTER TAXONOMY

This code is used for classifying health care providers according to provider type or practitioner specialty. (Refer to Section 13.2 for Taxonomy Codes).

Press the ENTER key to bypass if not required.

SERVICE TYPE

Enter the code identifying the type of service you are providing. (Refer to Section 13.2 for Service Type Codes).

Press the ENTER key to bypass if not required.

ORDERING PRV #

Enter the MMIS Provider ID number of the ordering provider and press the ENTER key. 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 license type and license number. If entering a license number for New York State providers, first enter a license type, followed by two zeros, then the six-digit license number. If entering out of state license numbers, first enter the license type, followed by the two-digit alpha character state code then the six-digit license number. NYS Nurse Practitioners who are allowed to prescribe will have an F preceding their license number. NYS Optometrists who are allowed to prescribe will have an alpha character (U or V) preceding their license number. When entering their license number, enter the license type followed by a zero, the alpha character and the six-digit license number.

 

Valid license types include:

 

                                In State         Out of State

 

Physician                      01                     11

Dentist                          02                     12

Physician’s Assistant     09                     19

Optometrist                   25                     35

Podiatrist                       26                     36

Audiologist                    27                     37

Nurse Practitioner          29                     39

Nurse Midwife                29                     39

 

 

Examples:

 

MMIS Provider ID                    01234567

New York State License #       0100987654

Out of State License #             11NJ345678

Nurse Practitioner #                290F121212

NYS Optometrist #                  250U452749

 

NOTE: When entering a license type 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: 250U000867 (License Type + 0U + Zero fill + License Number).

REFERRING PRV #

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 the ENTER key. 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 Medicaid ID number in response to this prompt.

 

If the client is not restricted or in MCCP, press the ENTER key to bypass this prompt.

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.

ENTER ITEM/NDC #

Enter the five-character HCPCS 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, or one character primary tooth or two-character tooth quadrant/arch.

ENTER QUANTITY

Enter the total number of units dispensed for the current date of service only. Do not include refills.

For Dental DVS: Enter the number of times the procedure was performed.

THIS ENDS THE INPUT DATA SECTION. The VeriFone will now dial into the MEVS system and display these processing messages:

DIALING, WAITING FOR ANSR, CONNECT XXXX, WAITING FOR ENQ, TRANSMITTING, and RECEIVING.

These processing messages are displayed.

 

 


8.2.6      Instructions for Completing Tran Type 7

 

Service Authorization and Eligibility Inquiry: This transaction must be used to obtain a service authorization for Post and Clear (PC) and Utilization Threshold (UT) programs by Pharmacy and Lab providers. Co-payment entries will be determined based on the entry in the number of Lab Tests, Generic/OTC, Brand, and Supplies prompts.

 

PROMPT DISPLAYED

ACTION/INPUT

 

TO BEGIN:

Press the CANCEL/CLEAR key.

Press the F4 key or swipe the CBIC card in the Magnetic Card Reader to start the verification.

ENTER CARD OR ID

If you are using the client access number, swipe the card through the reader or key the access number and press the ENTER key.

To use the card, smoothly swipe it through the magnetic stripe reader from top to bottom. “NY Access #” will be displayed for one second.

Note: The access number must be entered manually if using a replacement paper Benefit Identification Card or if using a plastic card with a damaged magnetic stripe. The six-digit ISO number on the Benefit Identification Card does not need to be entered when manually entering the access number.

If you are using the Client Medicaid number (CIN), enter the Medicaid number and press the ENTER key. The type of identification used will be displayed for one second.

ENTER TRAN TYPE

7    Service Authorization and Eligibility Inquiry: This transaction must be used to obtain a service authorization for Post and Clear (PC) and Utilization Threshold (UT) programs by Pharmacy and Lab providers. Co-payment entries will be determined based on the entry in the number of Lab Tests, Generic/OTC, Brand, and Supplies prompts.

 

Press the ENTER key.

ENTER SEQ #

If your Identification Number entry was a Medicaid ID number (CIN), enter the two-digit sequence number and press the ENTER key. The sequence number is the last two-digits of the access number.

If the Access Number was entered, this prompt will not display.

ENTER DATE

Press the ENTER key for today's date. If you are doing a transaction for a previous date of service, you must enter the eight-digit date, MMDDCCYY, and press the ENTER key.

SELECT PROVIDER

If you see this prompt, there are multiple provider numbers programmed into this terminal. Enter the appropriate shortcut code associated with your provider Identification Number or enter an eight-digit MMIS Provider ID and press the ENTER key (To add numbers call 1-800-343-9000).

ENTER TAXONOMY

This code is used for classifying health care providers according to provider type or practitioner specialty. (Refer to Section 13.2 for Taxonomy Codes).

Press the ENTER key to bypass if not required.

SERVICE TYPE

Enter the code identifying the type of service you are providing. (Refer to Section 13.2 for Service Type Codes).

Press the ENTER key to bypass if not required.

ORDERING PRV #

Enter the MMIS Provider ID number of the ordering provider and press the ENTER key. 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 license type and license number. If entering a license number for New York State providers, first enter a license type, followed by two zeros, then the six-digit license number. If entering out of state license numbers, first enter the license type, followed by the two-digit alpha character state code then the six-digit license number. NYS Nurse Practitioners who are allowed to prescribe will have an F preceding their license number. NYS Optometrists who are allowed to prescribe will have an alpha character (U or V) preceding their license number. When entering their license number, enter the license type followed by a zero, the alpha character and the six-digit license number.

 

Valid license types include:

 

                                In State         Out of State

 

Physician                      01                     11

Dentist                          02                     12

Physician’s Assistant     09                     19

Optometrist                   25                     35

Podiatrist                       26                     36

Audiologist                    27                     37

Nurse Practitioner          29                     39

Nurse Midwife                29                     39

 

Examples:

 

MMIS Provider ID                    01234567

New York State License #       0100987654

Out of State License #             11NJ345678

Nurse Practitioner #                290F121212

NYS Optometrist #                  250U452749

 

NOTE: When entering a license type 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: 250U000867 (License Type + 0U + Zero fill + License Number).

REFERRING PRV #

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 the ENTER key. 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 Medicaid ID number in response to this prompt.

 

If the client is not restricted or in MCCP, press the ENTER key to bypass this prompt.

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 except from co-payment, enter 2 for no.

NOTE: Bypassing this prompt will enter a 2 for no.

NOTE:  The system will default the copay type based on the entry in the number of Lab tests, number of Generic/OTC, number of Brand, and number of Supplies prompts.

# LAB TESTS

Enter the number of lab tests you are performing and press the ENTER key. If no lab tests are required, bypass by pressing the ENTER key.

NOTE: The # Generic/OTC, # Brand and # Supplies prompts will be displayed only if the # LAB TESTS prompt is bypassed.

# Generic/OTC