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Florida Medicaid Patient Verification 

Medicaid will not reimburse a provider for a service unless FMMIS shows that a recipient is eligible on the date of service. It is the provider’s responsibility to verify a patient’s Medicaid eligibility prior to providing any Medicaid reimbursable services.

Ways to Access Recipient Information

Eligibility and benefit information (MEVS) is available to providers via the following:

    • Point of Sale (POS) devices;
    • Computer software that can be added to a personal computer; x Automated voice response that generates a report with all the eligibility information for a particular recipient, which is automatically faxed to the provider’s fax machine;
    • Automated voice response that provides eligibility information using a touch-tone telephone;
    • Secure area on the Medicaid fiscal agent’s Web site;
    • PDA at www.evs.flmmis.com (only a registered provider with a PDA will have access to this site); and
    • X12N 270/271 Health Care Eligibility Benefit Inquiry and Response.

Information Available

The following recipient eligibility information for services rendered within the past 12 months is available from all the above sources:

    • Medicaid program code;
    • Hospital and other service limitations;
    • Managed care membership;
    • Third party insurance coverage and policy number;
    • Medicare number;
    • Medicare Part A & B coverage; and
    • Nursing home status

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:

    • Ten-digit recipient Medicaid ID number;
    • Eight-digit plastic card control number; or
    • The recipient’s social security number and date of birth.

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.

Reference

Florida Medicaid Provider General Handbook

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