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Ways to Access Recipient Information
Eligibility and benefit information (MEVS) is available to providers via the following:
The following recipient eligibility information for services rendered within the past 12 months is available from all the above sources:
Eligibility Program Codes
The Medicaid program for which a recipient is eligible is identified on the FMMIS by a unique alpha identifier called a program code. The provider needs to know a recipient’s program code before providing services, because some program codes indicate benefit limitations.
Medicaid Eligibility Verification Systems (MEVS)
MEVS transactions may be submitted using personal computer (PC) software or POS devices provided by MEVS switch vendors. When using a POS device the Medicaid card can be swiped through the terminal’s card reader slot, or the recipient access information can be entered by hand. This option is not available when using PC software or automated voice response. Various switch vendors offer differing methods for gaining access to the eligibility system. They communicate with the FMMIS to obtain detailed recipient eligibility and coverage information.
MEVS information is available 24 hours a day, seven days per week. There is a charge for each transaction and rates depend on the MEVS switch vendor selected.
MEVS Trace Number
A trace number is provided to uniquely identify each eligibility transaction submitted. The provider must retain the trace number in the recipient’s medical record in case a discrepancy in the recipient’s eligibility arises. The trace number is the key to obtaining the eligibility information that was returned on the original inquiry.
Automated Voice ResponseFaxBACK
This verification method requires a fax machine and a touch-tone telephone.
To obtain eligibility information, the provider enters the nine-digit provider number, date of service, and one of the following:
A voice response message will be received giving eligibility status, followed immediately by a hard copy report to the provider’s fax location. The hard copy fax page serves as the provider’s verification of eligibility.
To update the fax number on the provider’s file, call the Provider Contact Center at 800-289-7799 and select Option 7. The fax number can also be updated using the Web site at www.mymedicaid-florida.com. Select Secure Information for Providers, then Provider Demographic Maintenance, and then Location Name and Address.
This method is available 24 hours a day, seven days a week. This service is free and all providers are automatically enrolled.
Automated Voice Response System Verification
The Automated Voice Response System (AVRS) is a free service that is available to check eligibility information 24 hours a day, seven days a week. The telephone number is 800-239-7560.
AVRS is synthesized voice response for eligibility, spans of eligibility, and check inquiry only. Providers must have a touch-tone phone to use AVRS. The provider can make five inquires per AVRS call. No enrollment is necessary. All enrolled Medicaid providers may use AVRS.
AVRS Trace Number
A trace number is provided to uniquely identify each eligibility transaction submitted. The provider must retain the trace number in the recipient’s medical record in case a discrepancy in a recipient’s eligibility arises. The trace number is the key to obtaining the eligibility information that was returned on the original inquiry.
Human Operator Verification
A provider can verify eligibility and determine coverage limitations by calling the Provider Contact Center at 800-289-7799, Monday through Friday, 7:00 a.m. to 6:00 p.m., Eastern Time, and selecting Option 7. English and Spanish speaking operators are available. The phone number is on the back of the Medicaid ID card.
The provider gives the associate the control number on the front of the recipient’s Medicaid ID card or the recipient’s ten-digit Medicaid ID number and requests information as needed. Providers are limited to two inquires per phone call.
The associate will tell the provider if the recipient is Medicaid eligible on the date of service, the recipient’s ten-digit Medicaid ID number and eligibility program code, and if the recipient has exceeded the Medicaid coverage limitations.
The associate will not give the provider an audit number; therefore, the provider will not have proof of the recipient’s eligibility if a discrepancy arises.
A provider can verify eligibility and determine coverage limitations by accessing the Medicaid fiscal agent’s Web site at www.mymedicaidflorida.com. Select Secure Information for Providers, and then Recipient Eligibility. The provider must be enrolled with Medicaid and have a PIN number that allows access to the Web site. Once the provider is logged in to the secure site, recipient eligibility can be accessed by the card control number, the Medicaid identification number, or the social security and date of birth.
Florida Medicaid providers who are enrolled with the Medicaid fiscal agent’s Electronic Data Interchange (EDI) and are submitting electronic transactions to EDI Gateway may also submit HIPAA compliant X12N 270 (Eligibility Benefit Inquiry) transactions to receive the HIPAA-compliant X12 271 responses. There is no charge for this service.
Information on EDI is available on the Medicaid’s fiscal agent’s Web site at www.mymedicaid-florida.com. Select Public Information for Providers, then Provider Support, and then EDI. Information is also available by calling 866-586-0961 or 800-289-7799 and selecting Option 3.