The eligibility request format is called the HIPAA 270 Health Care Eligibility Benefit Inquiry format (also known as 270 Eligibility Inquiry). It is vital that you verify the recipient's eligibility through the Eligibility Verification System (EVS) each time the recipient is seen. This is pursuant to the 18 visit limit, during the July 1 through June 30 state fiscal year service period. Pennsylvania Medical Assistance (MA) PROMISe™ Eligibility Verification System (EVS) Providers can submit individual web interactive EVS requests via the PROMISe™ Internet. This is pursuant to the 18 visit limit, during the July 1 through June 30 state fiscal year service period. However, you should not assume that a patient is eligible whether they are able to present a valid identification card or not. The PROMISe™ Eligibility Verification System (EVS) enables you to determine a Medical Assistance recipient’s eligibility as well as their scope of coverage. 5. If a card is needed immediately, an interim paper card can be issued by the CAO. h�b```a``������0�A���2�@�������aT\��'��)F���p V ��3���(���2�=���� � Payment will not be made for ineligible recipients. The interim card contains the same Recipient Number and Card Issue Number as the previous ACCESS card.
This is pursuant to the 18 visit limit, during the July 1 through June 30 state fiscal year service period. e ™ Eligibility Verification System (EVS) before billing a MA beneficiary. Recipient information is listed on the front of the card and includes the full name of the recipient, a 10-digit recipient number, and a 2-digit card issue number. If, however, you, use the recipient's social security number and date of birth, you may receive an eligible response because both of these. EVS does not provide eligibility information when a provider attempts to verify eligibility using a lost or stolen ACCESS card. benefits associated with other programs, the recipient will be authorized for those services under a separate healthcare benefits package. The recipient is not MA eligible if they only have EPOMS. If not, EVS indicates the number of countable office visits, clinic and home visits remaining within the scope of. A recipient’s eligibility is subject to change; If, however, you use the recipient's social security number and date of birth, you may receive an eligible response because both of these elements are most likely accurate. The eligibility response format is called the HIPAA 271 Health Care Eligibility Benefit Response (also known as 271 Eligibility Response). Proudly founded in 1681 as a place of tolerance and freedom. Providers and other approved agencies that submit electronic requests in the 270 format will receive an EVS response with eligibility information in the 271 format. Batch EVS capabilities have been built into the, Providers have the option to submit individual EVS requests by telephone. 2. Prior to performing services, you should review the MA Bulletins related to SelectPlan. devices for women who are not otherwise eligible for MA. The MHX category is only used for tracking mental health service encounter claims for County Mental Health Funded Base Programs. 6. Please enable scripts and reload this page. endstream
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Again, it is often easier for us to research your specific problem if you write us. Providers can submit individual web interactive EVS requests via the, Batch EVS requests need to be submitted utilizing the ANSI X12 v5010 270/271 transaction sets. It is important to verify and submit accurate recipient information when checking eligibility via the EVS. Provider Electronic Solutions Software, or through their own certified software. Payment will not be made for ineligible recipients. All Medical Assistance (MA) providers should check the PROMIS. Please enable scripts and reload this page. Using the COMPASS questionnaire, those who wish to apply for benefits can see if they or anyone in their household may get approved. information returned from EVS is consistent across all methods of submission; however, depending upon the information submitted on the inquiry, the results may be different. The Eligibility Verification System (EVS) has been enhanced to inform providers when a recipient has exceeded the 18 visit limit. EVS will accept and return the standardized electronic transaction formats for eligibility requests and responses as mandated by the Health Insurance Portability and Accountability Act (HIPAA). Sometimes when I check a patient's eligibility on EVS using their recipient ID number, the coverage shows as not effective. A participant’s eligibility is subject to HCB 15 is SelectPlan for Women. If not, EVS indicates the number of countable office visits, clinic and home visits remaining within the scope of benefits for adult MA and adult GA recipients. Prior to performing services, you should review the MA Bulletins related to SelectPlan. On this version of the card, the client's full name and card number are on the bottom left, while the top left corner has a keystone and 'Pennsylvania', and the upper right-hand corner has the letters 'EBT'. If those methods are not available, they can access the EVS through the Automated Voice Response System by calling 1-800-766-5387 and entering the recipient's social security number and date of birth. It is vital that you use EVS to verify eligibility each time you provide a service. The EBT card is issued to MA recipients who receive cash assistance and/or food stamps as well as medical services, if eligible. EVS should be accessed on the date the service is provided since the recipient's eligibility is subject to change. The card issue number is voided to prevent misuse when the new card is issued. Both formats may also be referenced by the 3-digit transaction number, 270 and 271. For additional information, please refer to Medical Assistance Bulletin 99-07-10 or the 18-visit limit procedure code chart which can be found on the department's website at 18 Visit Limit Chart, 8. The interim card contains the same Recipient Number and Card Issue Number as the previous ACCESS card. Recipients who are eligible for medical benefits only will receive the yellow ACCESS card. elements are most likely accurate. This program provides coverage of selected family planning services, pharmaceuticals, and. endstream
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If the old card is found or returned after a new card is obtained, the old card should be destroyed by the recipient, as it is no longer usable. The eligibility response format is called the HIPAA 271 Health Care Eligibility Benefit Response (also known as 271 Eligibility Response). �3LΌ��B|00,8Ò��`a_�}��bZ�K ��1�Μ2 �@ �����Hs2��^g�` HV& Prior to performing services, you should review the MA Bulletins related to SelectPlan at the following URL: https://www.dhs.pa.gov/docs/For-Providers/Pages/Bulletin-Search.aspx, Develop a skilled workforce that meets the needs of Pennsylvania's business community, Provide universal access to high-quality early childhood education, Provide high-quality supports and protections to vulnerable Pennsylvanians. 4. This program provides coverage of selected family planning services, pharmaceuticals, and devices for women who are not otherwise eligible for MA. The purpose of EVS is to provide the most current information available regarding a recipient's MA eligibility and scope of coverage. We are having difficulty reading the EVS printout. This ensures recipients of uninterrupted medical services. There are several types of Pennsylvania ACCESS cards providers may encounter. The eligibility request format is called the HIPAA 270 Health Care Eligibility Benefit Inquiry format (also known as 270 Eligibility Inquiry). 1. How can I determine if a recipient is eligible for Medical Assistance (MA)/Medicaid if they do not have their ACCESS Card?All eligible recipients (including those recipients enrolled in a managed care organization [MCO]) will have a permanent identification card that identifies their eligibility for covered MA services. %%EOF
This ensures recipients of uninterrupted medical services. Keystone State. Proudly founded in 1681 as a place of tolerance and freedom. Step 2 - Send us an e-mail — promise@pa.gov Step 3 - Write to us — If you do not have access to e-mail, please write to us. In addition, the newly redesigned EBT card has entered into circulation. You may be trying to access this site from a secured browser on the server. 102 0 obj
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For example, if you perform an inquiry using the 10-digit recipient ID number and the two-digit card issue number, and either one of those data elements is incorrect (most likely the card issue number, as you must use the most current card issue number), you will receive an ineligible response. �g�k&�Dm�p�eR���ƣ�L ��(�h{M�`�AWH�B�H֡AU�̢,�0���K8Z�d�q�������2(IA�cHJ@+IŤ�%�F#�Vi���d,Sܐ���ka�,i����V�AK �9�%�dZ��J��Y��L+K���#-�t�'l��S�3#9
�$��0lL��Z0�i�8H+HF+f��!ͬ�CІYK;Ֆa7��~���\g�~��n�.������3���4��l��?֫j2]�9Y5eSM���*{yr��]C��q4/��>TwM�x��إV�6zbN�NB(��f�����\V������džV}[��sr����e�����!Y��K��5��ݕL�H��b�qb>$8�Q�_�i��g�/����n���F��U����t:�X�����C�HF'���u7�������Ĵ�y�����?5�I�]TI�k���_�W�McLr�I�����CD[P�C��|��,k솺�i )�jʇ��tv�P1����)6�e��/�*�Ep���o00��A�-�E3_f��K���. The Eligibility Verification System (EVS) has been enhanced to inform providers when a recipient has exceeded the 18 visit, limit. The dial-up (modem) Bulletin Board System (BBS) solution for electronic file management was decommissioned at the end. Is there a manual available on how to read the printout and actually use it via modem submission?The dial-up (modem) Bulletin Board System (BBS) solution for electronic file management was decommissioned at the end of May 2011. However, you should not assume that a patient is eligible whether they are able to present a valid identification card or not. You may be trying to access this site from a secured browser on the server. benefits for adult MA and adult GA recipients. EVS should be accessed on the date the service is provided since the recipient's eligibility is subject to change. How can I determine if the recipient has exceeded 18 office visits for the fiscal year?The Eligibility Verification System (EVS) has been enhanced to inform providers when a recipient has exceeded the 18 visit limit. Pennsylvania Medical Assistance (MA) PROMISe™ Eligibility Verification System (EVS), Develop a skilled workforce that meets the needs of Pennsylvania's business community, Provide universal access to high-quality early childhood education, Provide high-quality supports and protections to vulnerable Pennsylvanians. This redesigned card has a background photo of the PA State Capitol building framed by cherry blossom branches. The PROMISe™ Eligibility Verification System enables a provider to determine a Medical Assistance recipient’s eligibility as well as their scope of coverage. A. h��Ymo�8�+�K��Z|Y���h{�&�Y@�5֥�%�a�����gHɖŕ���p0��9$��3� What if the EVS response displays that a recipient only has service program category MHX and service program EPOMS?The recipient is not MA eligible if they only have EPOMS.