NEW YORK STATE PROGRAMS

MEVS 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 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

 
VOICE PROMPT                                             ACTION/INPUT

 

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 recipient’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 ID 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 referring

NUMBER                                                         provider.  Press #.

 

                                                                        If the recipient 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.

 

VOICE PROMPT                                             ACTION/INPUT

 

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.

 

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 the total

PROVIDER, ENTER NUMBER OF LAB            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 the total

PROVIDER, ENTER NUMBER OF                    number of prescriptions or over the counter items being

PRESCRIPTIONS OR OVER THE                    ordered and Press #, or Press # to bypass.

COUNTER ITEMS YOU ARE ORDERING

 

ENTER ORDERING PROVIDER                        Enter the MMIS provider ID number or License Type

NUMBER                                                         and License Number of the ordering provider, if applicable.  Press #.

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RESPONSES

 

TELEPHONE RESPONSE                                DESCRIPTION/COMMENTS

 

MEDICAID NUMBER AA22346D                    The response begins with the recipient’s eight-digit Medicaid CIN.

 

COUNTY CODE 24                                          Recipient’s two-digit county code.

 

ELIGIBLE CAPITATION GUARANTEE           Indicates guaranteed status under a Prepaid Capitation Program (PCP).

 

ELIGIBLE EXCEPT LONG TERM CARE         Recipient is eligible to receive all Medicaid services except for Long Term Care.

 

ELIGIBLE ONLY FAMILY PLANNING            Recipient is eligible for Medicaid covered family

SERVICES                                                       planning services.

 

ELIGIBLE ONLY OUTPATIENT CARE           Recipient is eligible for all ambulatory care, including prosthetics, no inpatient coverage.

RESPONSES (contd.)

 

TELEPHONE RESPONSE                                DESCRIPTION/COMMENTS

 

ELIGIBLE PCP                                                Recipient covered by a Prepaid Capitation Program (PCP) as well as eligible for limited fee-for-service benefits.

 

EMERGENCY SERVICES ONLY                     Recipient is eligible for emergency services only.

 

FAMILY HEALTH PLUS                                 Recipient is enrolled in the Family Health Plus Program (FHP).

 

MEDICAID ELIGIBLE HR UTILIZATION         Recipient is eligible to receive all Medicaid services

THRESHOLD                                                   with prescribed limits.  A service authorization must be obtained for services limited under Utilization Threshold.

 

MEDICAID ELIGIBLE                                      Recipient is eligible for all benefits.

 

MEDICARE COINSURANCE AND                   Recipient is eligible for payment of Medicare

DEDUCTIBLE ONLY                                        coinsurance and deductibles only.

 

PERINATAL FAMILY                                     Recipient is eligible to receive a limited package of benefits.  See MEVS Manual for excluded services.

 

PRESUMPTIVE ELIGIBLE LONG-                  Recipient 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                          Recipient 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                          Recipient is eligible to receive only ambulatory

PRENATAL B                                                  prenatal care services.  See MEVS Manual for excluded services.

 

ANNIVERSARY MONTH OCTOBER               This is the beginning month of the recipient’s benefit year.

 

CATEGORY OF ASSISTANCE S                    Recipient is enrolled in the SSI assistance program.

 

MEDICARE PART A                                       Recipient has only Part A Medicare.

 

MEDICARE PART B                                        Recipient has only Part B Medicare.

 

MEDICARE PARTS A and B                          Recipient has both Parts A and B.

 

MEDICARE PARTS A & B & QMB                 Recipient has Part A and B Medicare coverage and is a Qualified Medicare Beneficiary (QMB).

 

MEDICARE PART A & QMB                          Recipient has Part A Medicare coverage and is a Qualified Medicare Beneficiary (QMB).

 

MEDICARE PART B & QMB                           Recipient has Part B Medicare coverage and is a Qualified Medicare Beneficiary (QMB).

 

RESPONSES (contd.)

 

TELEPHONE RESPONSE                                DESCRIPTION/COMMENTS

 

MEDICARE QMB ONLY                                  Recipient is a Qualified Medicare Beneficiary (QMB) Only.

 

HEALTH INSURANCE CLAIM NUMBER        Health Insurance Claim number.

XXXXXXXXXXXX

 

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 Insurance

DENTAL, PHYSICIAN, INPATIENT                 carrier and the scope of benefits.

 

EXCEPTION CODE 35                                     Recipient’s exception and/or restriction code.

 

NO CO-PAYMENT REQUIRED                        Recipient is under 21 or exempt from co-payment and co-payment data has been entered.

 

CO-PAYMENT REQUIREMENTS MET           Recipient has reached his/her co-payment maximum.

ON MM/DD/YY

 

AT SERVICE LIMIT                                        The recipient 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 service

APPROVED                                                     authorization.

 

PARTIAL APPROVAL XX SERVICE              Indicates that the full complement of requested services

UNIT(S), XX LAB UNIT(S), XX                       relative to Post and Clear processing is not available. 

PHARMACY UNIT(S) POST AND                  The XX represents the number of services

CLEAR                                                            approved/available.

 

PARTIAL APPROVAL XX SERVICE              Indicates that the full complement of requested services

UNIT(S), XX LAB UNIT(S), XX                       relative to Utilization Threshold processing is not

PHARMACY UNIT(S) UTILIZATION              available. The XX represents the number of services

THRESHOLD                                                   approved/available.

 

SERVICE APPROVED NEAR LIMIT               The service authorization has been granted and

XX SERVICE UNIT(S), XX LAB UNIT(S),       recorded.  The recipient 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

 

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                   Recipient has used an invalid card.

 

INVALID CO-PAYMENT                                 Invalid number of digits or number doesn't covert 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 recipient identification number not valid.

 

INVALID LICENSE TYPE                                License type 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 ID number or license number

NUMBER                                                         entered NUMBER was not found on the file.

 

INVALID PROVIDER NUMBER                       Provider number invalid.

 

INVALID REFERRING PROVIDER                   Referring provider ID number invalid.

NUMBER

 

INVALID SEQUENCE NUMBER                       The sequence number entered is not valid or not current.

 

ERROR RESPONSES (contd.)

 

TELEPHONE RESPONSE                                DESCRIPTION/COMMENTS

 

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                                    Recipient is restricted.  Services must be provided,

AUTHORIZATION                                           ordered, or referred by the primary provider.

 

NO COVERAGE EXCESS INCOME                 Recipient has an income in excess of the allowable levels and must spenddown the excess in order to be eligible.

 

NO COVERAGE PENDING FAMILY                Recipient 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                              Recipient is not eligible for benefits on the date of service entered.

 

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 number

SERVICE ON DATE PERFORMED                  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 number entered is not identified as a Medicaid enrolled provider.

 

RECIPIENT NOT ON FILE                               Recipient identification number (CIN) is not on file.  The number is either incorrect or the recipient 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 number to whom the recipient

AUTHORIZATION                                           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 Recipient Master file.

 

SYSTEM ERROR #                                          A network problem exists.  Call 1-800-343-9000 with the error number.

ERROR RESPONSES (contd.)

 

TELEPHONE RESPONSE                                DESCRIPTION/COMMENTS

 

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 PROGRAMS

MEVS INSTRUCTIONS USING VERIFONE TRANZ 330

 

·          FUNC/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 CLEAR key, press the 3 key to start the verification.

 

NY STATE PGRMS                                         Displayed for one second.

 

ENTER CARD OR ID                                        If you are using the recipient’s access number then swipe the card through reader, or key the access number then press the FUNC/ENTER key.

 

                                                                        If you are using the Recipient’s Medicaid number (CIN), enter the Medicaid number and press the FUNC/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 Request (DVS).

 

                                                                        Press the FUNC/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 FUNC/ ENTER key.  Note:  This prompt will not appear if the Access number was entered as it contains the sequence number.

 

ENTER DATE                                                   Press FUNC/ENTER for today’s date or enter MMDDCCYY for verification on a previous date of service.  Press the FUNC/ENTER key.

 

 

PROMPT DISPLAYED                                    ACTION/INPUT

 

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 FUNC/ENTER key (To add numbers call 1-800-343-9000)

 

ENTER SPEC CODE                                        If applicable, enter the three-digit specialty code and press the FUNC/ENTER key, or press FUNC/ENTER to bypass

 

REFERRING PRV #                                          Enter the Medicaid provider number of the referring provider.  For Restricted Recipients, enter their Primary Provider’s number.  Press the FUNC/ENTER key.

 

ORDERING PRV #                                           Enter the MMIS provider ID number or license type and State license number of the ordering provider, if applicable.  Press the FUNC/ENTER key.

 

NOTE:    The following three prompts are required for DVS transactions only and will only appear when Tran Type 6 is entered.

 

ENTER COS                                                    Enter the four-digit Category of Service assigned to your provider number.  Press the FUNC/ENTER key.

 

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.

 

                                                                        Press the FUNC/ENTER key.

 

ENTER QUANTITY                                          Enter the total number of units dispensed for the current date of service only.  For enteral products, enter caloric units.

 

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

 

                                                                        Press the FUNC/ENTER key.

 

NOTE:    If performing a DVS transaction, the Enter Quantity prompt will be the last to appear. Co-payment amounts will be taken from the New York State Drug Plan file and added to the recipient's file for cap calculation unless the recipient has already met their co-payment or is exempt.  No co-payment amounts can be entered with the DVS transaction.

 

COPAY TYPE/UNT 1                                      Enter the alpha co-payment type and number of units or press enter to bypass the rest of the co-payment prompts.

 

COPAY TYPE/UNT 2                                      Enter the alpha co-payment type and number of units or press enter to bypass the rest of the co-payment prompts.

PROMPT DISPLAYED                                    ACTION/INPUT

 

COPAY TYPE/UNT 3                                      Enter the alpha co-payment type and number of units or press enter to bypass the rest of the co-payment prompts.

 

COPAY TYPE/UNT 4                                      Enter the alpha co-payment type and number of units or press enter to bypass the rest of the co-payment prompts.

 

# SERVICE UNITS                                           Enter the total number of service units.

                                                                        Press the FUNC/ENTER key.

 

NOTE:    If you are a POST and CLEAR Provider, enter the appropriate data for the following two prompts.  These prompts will only appear for a Post and Clear provider and an entry is required.

 

#LAB TESTS                                                  Enter the number of lab tests you are ordering.  Press the FUNC/ENTER key.

 

#RX/OTC                                                         Enter the number of prescriptions or over the counter items.  Press the FUNC/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 ANSWER,

CONNECTED, TRANSMITTING,

RECEIVING, and PROCESSING

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RESPONSES

 

After each Response Field display, press the # key to read the next display.

 

VERIFONE RESPONSE                                    DESCRIPTION/COMMENTS

 

AA22345D 04                                                 The response begins with the recipient’s eight-digit Medicaid CIN.  VeriFone response also displays the recipient’s two-digit county code.

 

ELIG CAPITATION                                         Indicates guaranteed status under a Prepaid

GUARANTEE                                                   Capitation Program (PCP).

 

ELIG EXCEPT LTC                                         Recipient is eligible to receive all Medicaid services except for Long Term Care.

 

ELIGIBLE ONLY                                              Recipient is eligible for Medicaid covered family

FAMILY PLAN SRVC                                     planning services.

 

ELIGIBLE ONLY                                              Recipient is eligible for all ambulatory care, including

OUTPATIENT CARE                                       prosthetics; no inpatient coverage.

 

ELIGIBLE PCP                                                Recipient covered by a Prepaid Capitation Program (PCP) as well as eligible for limited fee-for-service benefits.

 

EMERGENCY SRVCS                                     Recipient is eligible for emergency services only.

 

 

RESPONSES (contd.)

 

VERIFONE RESPONSE                                    DESCRIPTION/COMMENTS

 

FAM HEALTH PLUS                                       Recipient is enrolled in the Family Health Plus Program (FHP).

 

MA ELIG-HR/UT                                             Recipient is eligible to receive all Medicaid services with prescribed limits.  A service authorization must be obtained for services limited under Utilization Threshold Program.

 

MA ELIGIBLE                                                 Recipient is eligible for all benefits.

 

MDCRE COIN/DEDUC                                     Recipient is eligible for payment of Medicare coinsurance and deductibles only.

 

PERINATAL FAMILY                                     Recipient is eligible to receive a limited package of benefits.  See MEVS Manual for excluded services.

 

PRESUMPTIVE ELIG                                      Recipient is eligible for all Medicaid services except

LONGTERM/HOSPICE                                    hospital based clinic services, hospital emergency room services, hospital inpatient services, and bed reservation.

 

PRESUMPTIVE ELIG                                      Recipient 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 ELIG                                      Recipient is eligible to receive only ambulatory prenatal

PRENATAL B                                                  care services.  See MEVS Manual for excluded services.

 

10 F959 S 06 500                                            10    =  The anniversary month (October).

                                                                        F      =  Sex (Female).

                                                                        959  =  Year of birth is displayed showing the century and year of the recipient’s birth (1959).

                                                                        S      =  Category of assistance, SSI.

                                                                        06    =  Month client is due for re-certification (June).

                                                                        500  =  Valid NYC office code.

 

MEDICARE A                                                  Recipient has only Part A Medicare.

 

MEDICARE B                                                  Recipient has only Part B Medicare.

 

MEDICARE AB                                                Recipient has both Parts A and B.

 

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

 

MEDICARE PART A & QMB                          Recipient has Part A Medicare coverage and is a Qualified Medicare Beneficiary (QMB).

 

MEDICARE PART B & QMB                           Recipient has Part B Medicare coverage and is a Qualified Medicare Beneficiary (QMB).

 

MEDICARE QMB ONLY                                  Recipient is a Qualified Medicare Beneficiary (QMB)

Only.

 

HIC XXXXXXXXXXXX                                     Health Insurance Claim number.


RESPONSES (contd.)

 

VERIFONE RESPONSE                                    DESCRIPTION/COMMENTS

 

HIC NOT ON FILE                                           Health Insurance Claim number is not on file.

 

21 BEJK                                                          Insurance and Coverage Codes equal the insurance carrier and scope of benefits.

 

EXCP 35 46 ZZ                                               Recipient’s exception and/or restriction code.

 

NO COPAY REQD                                           Recipient is under 21 or exempt from co-payment and co-payment data has been entered.

 

COPAY MET MMDDYY                                  Recipient has reached his/her co-payment maximum.

 

APRVD NEAR LIMIT                                      The service authorization has been granted and recorded.  The recipient has almost reached his/her service limit for that particular category.

 

AT SERVICE LIMIT                                        The recipient has reached his/her limit for that particular service category.  No service authorization is created.

 

DUP UT AUTH                                                 Request is a duplicate of a previously approved service authorization.

 

PARTIAL APPROVAL                                   Indicates that the full complement of requested

NN/XX/XX PC                                                  services relative to Post and Clear processing is not available.  The NN represents the number of services available/approved.

 

PARTIAL APPROVAL                                   Indicates that the full complement of requested

NN/XX/XX UT                                                  services relative to Utilization Threshold processing is not available.  The NN represents the number of services available/approved.

 

SERVICE APRVD PC                                      The ordering provider has posted services and the units have been approved.

 

SERVICE APRVD UT                                      The service units requested are approved.

 

DVS RESPONSES                                           This response field will only be returned when a Dispensing Validation System (DVS) Transaction has been submitted.  Refer to last page for a list of responses.

 

FOR MMDDYY END                                        The date for which services were requested.

 

                                                                        This indicates the end of the message.

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ERROR RESPONSES

 

VERIFONE RESPONE                                      DESCRIPTION/COMMENTS

 

BAD TX COMMUN                                         Bad transmission communication exists with the network.

 

 

ERROR RESPONSES (contd.)

 

VERIFONE RESPONSE                                    DESCRIPTION/COMMENTS

 

CALL 800 3439000                                        Certain conditions are met (ex:  multiple responses), call the Provider Services staff for additional data.

 

CAN NOT CANCEL                                        Provider not allowed to cancel the previous authorization.

 

CANCELLED                                                   The transaction has been cancelled.

SS/XX/XXUT                                                   SS = The number of units cancelled.

SS/XX/XXPC                                                   UT = Utilization Threshold.

                                                                        PC = Post and Clear.

 

CONNECTED                                                   This message is displayed until transmission to the host computer begins.

 

DECEASED ORDERER                                     The Ordering Provider is deceased.

 

DISQUALIFIED ORDERER                               The Ordering Provider is identified as excluded/disqualified and cannot prescribe.

 

DOWNLOAD DONE                                         The download function is complete.

 

DOWNLOAD REQUIRD                                   The VeriFone software is obsolete and must be updated.

 

INV PRV SELECTED                                       A provider number selection was made that is not programmed into the terminal.

 

INV REF PRV #                                               Referring provider ID number was entered incorrectly or is invalid.

 

INV SPEC 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.

 

INV TERM ACCESS                                       The received transaction is classified as a Provider Type/Transaction Type Combination that is not allowed to be submitted through the POS VeriFone terminal.

 

INV TRANS TYPE                                           An invalid transaction type other than 1-4 or 6 was entered.

 

INVALID ACCESS #                                       An incorrect access number was entered.

 

INVALID CARD                                               Recipient has used an invalid card.

THIS RECIPIENT

 

INVALID DATE                                               Illogical date or a date which falls outside of the allowed inquiry period of 24 months.

 

INVALID LIC TYPE                                         License type not valid.

 

ERROR RESPONSES (contd.)

 

VERIFONE RESPONE                                      DESCRIPTION/COMMENTS

 

INVALID MDCAID #                                       Medicaid number (CIN) not valid.

 

INVALID ORDERING                                       Ordering provider ID number or license number was

PROVIDER                                                      not found on the file.

 

INVALID PRV #                                              An incorrect provider number was entered.

 

INVALID SEQ #                                               The sequence number entered is not valid or not current.

 

LOADING APPLN                                           This message is displayed if a download function is in process.

 

LOST/STOLEN TERM                                    The terminal serial ID is indicated as being a lost or stolen terminal.  Call 1-800-343-9000 for assistance.

 

MCCP REC NO AUTH                                    Recipient is restricted.  Services must be provided, ordered, or referred by the primary provider.

 

NO ANSWER                                                   The VeriFone is unable to connect with the network.

 

NO AUTH FOUND                                            No matching transaction found for the authorization confirmation transaction or cancellation request.

 

NO COV:EXCESS                                           Recipient has income in excess of the allowable levels, and must spenddown the excess in order to be eligible.

 

NO COVERAGE:                                             Recipient is waiting to be enrolled into a Family Health

PENDING FHP                                                 Plus Managed Care Plan.

 

NO DEVICE ACCESS                                      The received Transaction Type is not allowed to be submitted through the POS VeriFone Terminal by any Provider Type.

 

NO ENQ FROM HOST                                     No enquiry received from host.  A problem exists with the network.

 

NO PROV ACCESS                                        The provider is not authorized to access the system using a social security number.

 

NO RESP FRM HOST                                      No response received from host.  A problem exists with the network.

 

NO UNITS ENTERED                                       No entry was made and the units are required for this transaction.

 

NOT MA ELIGIBLE                                         Recipient is not eligible for benefits on the date of service entered.

 

PAYMENT PAST DUE                                    The terminal serial ID is indicated as having past due payments.  Call 1-800-343-9000 for assistance.

 

 

ERROR RESPONSES (contd.)

 

VERIFONE RESPONE                                      DESCRIPTION/COMMENTS

 

PLEASE TRY AGAIN                                      The card swipe was unsuccessful.

 

PRESCRIBING PRV                                        License number is not active for the date of service

LICENSE INACTIVE                                        entered.

 

PROCESSING                                                 The message is displayed until the host message is     ready to be displayed.

 

PRV INELIG SERVC                                       The category of service for the provider number

ON DATE PERFORMD                                    submitted in the transaction is inactive or invalid for the Date of Service entered.

 

PRV NOT ELIG                                               The verification was attempted by an inactivated or disqualified provider.

 

PRV NOT ON FILE                                          The provider number entered is not identified as a Medicaid enrolled provider.

 

RCIP NOT ON FILE                                         Recipient identification number (CIN) is not on file.  The number is either incorrect or the recipient is no longer eligible and the number is no longer on file.

 

RECEIVING                                                     This message is displayed until the host message is received by the VeriFone.

 

REENTER COPAY                                           An invalid COPAY TYPE code was entered or an invalid numeric UNT was entered.

 

REENTER ORD PRV                                        Ordering provider number or license number has an incorrect format (wrong length or characters in the wrong position).

 

RST RECP NO AUTH                                      Enter the MMIS provider number to whom the recipient is restricted.

 

RETRY TRANS                                                After a successful Transaction has been completed, this message will be received during the Review Function if an invalid sequence of keys is pressed or an Access Number is entered which differs in length from the original number.

 

SRVC NOT ORDERED                                     The ordering provider did not post the services you are trying to clear.

 

SSN ACCESS NOT                                         The provider is not authorized to access the system

ALLOWED                                                      using a social security number.

 

SSN NOT ON FILE                                          The entered nine-digit number is not on the Recipient Master File.

 

SYS ERROR XXX                                            A network problem exists.  Call 1-800-343-9000 with the error number.

 

ERROR RESPONSES (contd.)

 

VERIFONE RESPONE                                      DESCRIPTION/COMMENTS

 

TRANSMITTING                                             This message is displayed until the host computer acknowledges the transmission.

 

UNREADABLE CARD                                      Will be displayed after three unsuccessful attempts to swipe the card.

 

WAITING FOR ANSR                                      This message is displayed until connection is made with the network.

 

WAITING FOR LINE                                        The VeriFone terminal is not plugged in or the terminal is on the same line as a telephone, which is off the hook or in use.

 

DISPENSING VALIDATION SYSTEM RESPONSES

 

The responses listed in this section will be returned when a DVS transaction (Tran Type 6) is submitted.  Please note that most of the responses are reject messages and require the transaction to be resubmitted.

 

VERIFONE RESPONSE                                    DESCRIPTION/COMMENTS

 

AGE EXCEEDS MAX                                       The recipient’s age exceeds the maximum allowable age.

 

AGE PRECEDES MIN                                      The recipient’s age is below the minimum allowable age.

 

COPAY $- - - - . - -                                         Co-payment amount for the item submitted, when applicable.

 

COS/ITEM INVALID                                       Category of service is not reimbursable for the item entered.

 

CURRENT DATE REQ                                     Date entered was not today’s date.

 

DUPLICATE DVS                                            Duplicate of a previously submitted and approved transaction.

 

DVS #- - - - - - - -                                            Transaction is approved.  The eight-digit number should be put on the claim form when billing for the DME item.

 

DVS NOT INVOKED                                        Transaction not processed through the DVS System.  If further clarification is required, call 1-800-343-9000.

 

DVS NOT REQUIRED                                      Item/NDC code does not require a DVS number.

 

EXCEEDS FREQ LMT                                     The allowed quantity limit within the specified time frame has been reached.

 

 

 

SYSTEM RESPONSES (contd.)

 

VERIFONE RESPONSE                                    DESCRIPTION/COMMENTS

 

FHP DENIAL                                                    The recipient is enrolled in the Family Health Plus Program (FHP) and receives all services through a FHP participating Managed Care Plan.

 

ITEM/GENDER INV                                          Item/NDC code not reimbursable for the recipient’s gender.

 

ITEM NOT COVERED                                     Item/NDC code not reimbursable or has been discontinued.

 

M/I COS                                                          Category of Service is invalid or missing or is not on the provider’s file.

 

M/I DVS QUANTITY                                       Quantity’s format is invalid or missing.

 

M/I ITEM CODE                                              Item/NDC code’s format is invalid or missing.

 

M/I TOOTH/QUAD                                          Tooth number, tooth quadrant, or arch is invalid or missing.

 

MAX QTY EXCEEDED                                     Quantity exceeds the maximum allowed.

 

PROC CD NOT COV                                       Procedure code not covered or entered incorrectly.