Louisiana Medicaid Management Information Systems (LA MMIS
Contents
1. 4 3 Inquire By SSN and DOB Z LOUISIANA MEDICAID Microsoft Internet Explorer 8 x File Edit View Favorites Tools Help Back gt A A Asearch fayravorites media C B GB 8 A Address Links Z Louisiqna 7 edicaid Provider Logout Medicaid Eligibility Verification Web Application HIPAA Information Center About Medicaid Provider Enrollment ELIGIBILITY INQUIRY Instructions ELEC By Card Control Number and DOB Billing Information By Card Control Number and SSN Provider Update By SSN and DOB Remittance Advice Index By Recip ID and DOB Pharmacy Prescribing By Recip ID and SSN Providers By Recip ID and Name Current Hewsletter RA Bv Name and DOB Helpful Humbers By Name and SSN FAQ Useful Links FormsFiles Home il e By ap internet 1 Click the By SSN and DOB hyperlink The following screen for this inquiry is displayed Medicaid Eligibility Verification Web Application Eligibility Inquiry by SSN amp DOB Transaction Set Control Number Reference ID Provider Type x Provider ID 7 digits Social Security Number Date of Service CCYYMMDD Subscriber Birth Date CCYYMMDD Return to Main Menu EDI UM LA WEB Web Application User Manual 06 17 2003 UNISYS EDI Solutions Group 06 17 2003 2 Enter the values for each of the fields being sure to enter all mandatory fields Mandatory2. By Name and DOB By Name and SSN Useful Links Forms Files Home ie PO E fep internet 1 Select the By Name and SSN hyperlink The following screen for this inquiry is displayed Medicaid Eligibility Verification Web Application Eligibility Inquiry by Name amp SSN Send Message Reset Transaction Set Control Number Reference ID Provider Type z Provider ID 7 digits Recipient Last Name Recipient First Name Social Security Number l Date of Service CCYYMMDD l Return to Main Menu EDI UM LA WEB Web Application User Manual 23 of 30 UNISYS EDI Solutions Group 06 17 2003 2 Enter the values for each of the fields being sure to enter all mandatory fields Mandatory field titles are displayed in red Transaction Set Control Number Optional This is the STO2 field of the 270 transaction created and will be echoed back in the STO2 field of the 271 response message Use this as a tracking number to correlate inquiry to response Reference ID Optional This is the BHTO3 field of the 270 transaction created and will be echoed back in the BHT03 field of the 271 response message Use this as a tracking number to correlate inquiry to response Provider Type Mandatory Select the provider type from the pull down menu 1 Person 2 Non person Entity This field will default to 1 Person Provi
3. ELIGIBILITY INQUIRY By Card Control Number and DOB By Card Control Number and SSN By SSN and DOB By Recip ID Q By Recip ID and SSN By Recip ID and Name By Name and DOB By Name and SSN E T B internet 1 Click the By Card Control Number and DOB hyperlink The following screen for this inquiry is displayed Send Message Reset Medicaid Eligibility Verification Web Application Eligibility Inquiry by CCN amp DOB Transaction Set Control Number Reference ID Provider Type x Provider ID 7 digits Card Control Number 16 digits Subscriber Birth Date CCYYMMDD Date of Service CCYYMMDD Card Issue Date CCYYMMDD Return to Main Menu EDI UM LA WEB Web Application User Manual 9 of 30 UNISYS EDI Solutions Group 06 17 2003 2 Enter the values for each of the fields being sure to enter all mandatory fields Mandatory field titles are displayed in red Transaction Set Control Number Reference ID Provider Type Provider ID Card Control Number Subscriber Birth Date Date of Service Card Issue Date Optional Optional Mandatory Mandatory Mandatory Mandatory Mandatory Mandatory This is the STO2 field of the 270 transaction created and will be echoed back in the STO2 field of the 271 response message Use this as a tracking number t
4. Instructions Provider Support Billing Information Provider Update Remittance Advice Index Pharmacy Prescribing Providers Current Newsletter RA Helpful Numbers FAQ LoS Rai ud Medicaid Eligibility Verification Web Application ELIGIBILITY INQUIRY By Card Control Number and DOB By Card Control Number and SSN By SSN and DOB By Recip ID Q By Recip ID and SSN By Recip ID and Name By Name and DOB By Name and SSN Useful Links Forms Files Home e L E A fap internet 1 Click the By Card Control Number and SSN hyperlink The following screen for this inquiry is displayed Medicaid Eligibility Verification Web Application Eligibility Inquiry by CCN amp SSN Send Message _Reset Transaction Set Control Number Reference ID Provider Type T Provider ID 7 digits Social Security Number Card Control Number 16 digits Date of Service CCYYMMDD Card Issue Date CCYYMMDD Return to Main Menu EDI UM LA WEB Web Application User Manual 11 of 30 UNISYS EDI Solutions Group 06 17 2003 2 Enter the values for each of the fields being sure to enter all mandatory fields Mandatory field titles are displayed in red Transaction Set Control Number Optional This is the STO2 field of the 270 transaction created and will be echoed back in the STO2 field of the 271 response
5. Main Menu EDI UM LA WEB Web Application User Manual 15 of 30 UNISYS EDI Solutions Group 06 17 2003 2 Enter the values for each of the fields being sure to enter all mandatory fields Mandatory field titles are displayed in red Transaction Set Optional This is the STO2 field of the 270 transaction created Control Number and will be echoed back in the STO2 field of the 271 response message Use this as a tracking number to correlate inquiry to response Reference ID Optional This is the BHTO3 field of the 270 transaction created and will be echoed back in the BHTO3 field of the 271 response message Use this as a tracking number to correlate inquiry to response Provider Type Mandatory Select the provider type from the pull down menu 1 Person 2 Non person Entity This field will default to 1 Person Provider ID Mandatory Enter the 7 digit provider ID Recipient ID Mandatory Enter the 13 digit recipient ID Subscriber Birth Mandatory Enter the Subscriber s Birth Date in the format Date CCYYMMDD For example enter 19620417 for a birth date of April 17 1962 Date of Service Mandatory Enter the Date of Service in the format CCYYMMDD For example enter 20030409 for a service date of April 9 2003 3 When all fields have been entered click the Send Message button If any mandatory fields have not been entered an alert message will be displayed Clic
6. resubmit it Medicaid Eligibility Verification Web Application Response Field ID Field Title Value EDI UM LA WEB Web Application User Manual 29 of 30 e UNISYS EDI Solutions Group 06 17 2003 STO2 Transaction Set Control Number 54321 BHT03 Reference ID 11234 HLO3 Hierarchical Level Code Information Source NM101 Entity ID Code Payer NM103 Last Name Org Name UNISYS LAMMIS NM108 ID Code Qualifier Payor ID NM109 ID Code 610551 HLO3 Hierarchical Level Code Information Receiver NM101 Entity ID Code Provider NM108 ID Code Qualifier Service Provider Number NM109 ID Code 1111112 HLO3 Hierarchical Level Code Subscriber NM101 Entity ID Code Insured or Subscriber NM108 ID Code Qualifier Member ID Number NM109 ID Code 5304008500701 AAA01 Valid Request Indicator Yes AAA03 Reject Reason Code Patient Not Found AAA04 Follow up Action Code Please Correct and Resubmit DMGO02 Birth Date 19691021 DTPO1 Date Time Qualifier Service DTPOS3 Date 20021115 Return to Main Page Return to Main Menu The page can be printed by clicking the printer icon on the web browser NOTE The privacy of the recipient should be safeguarded To enter another inquiry of the same type Name and DOB for instance click the Return to Main Page button To enter an inquiry of a different type than the last inquiry click the Return to Main Menu hyperlink EDI UM LA WEB W
7. AA Information Center About Medicaid Dlease enter your 7 Digit Medicaid Provider ID Number Provider Enrollment Instructions AI NOTICE TO USERS Billing Information Provider Update This is Louisiana s Medicaid information and is the property of Unisys and Department of Health and Hospital It is for authorized use only Users authorized or unauthorized have no explicit or implicit expectation of privacy Remittance Advice Index Pharmacy Prescribing Providers Current Newsletter andRA Any or all uses of this website and all files on this system may be Helpfulllumbers intercepted monitored recorded copied audited inspected and Eaa disclosed to authorized site Department of Health and Hospital UsefulLinks land law enforcement personnel as well as authorized officials of FormsFiles other agencies both domestic and foreign By using this system Home he user consents to such interception monitoring recording copying auditing inspection and disclosure at xl Done O 8 Sp interne 4 Enter the test Provider ID Number in the area provided and click the Enter button The following screen is displayed EDI UM LA WEB Web Application User Manual 5 of 30 UNISYS EDI Solutions Group 06 17 2003 yj LOUISIANA MEDICAID Microsoft Internet Explorer alx Fie Edt view Favorites Tools Help Back gt A A Asearch GFavoites BPmeda lt 4
8. D 3A 8 A Address Links zi HOMES HA cdicaid EZ Provider Logout HIPAA Information Center About Medicaid Provider Enroliment Instructions Provider Support Billing Information Provider Update Remittance Advice Index Pharmacy Prescribing Providers Current Newsletter and RA Helpful Numbers Provider Logout Help E FS Provider Applications Area The application s listed below are for authorized use only Click on an application link to access the application Provider Applications Provider Demographics Restricted Provider Applications Please enter your Restricted Applications Login ID and Password Remember the Login ID and Password are case sensitive LoginID FAQ Password Useful Links Forms Files Home Forgot Your Login ID Forgot Your Password zl Done DO 8 ep nternet 5 Enter the test Login ID and password 6 Click the Login button The following screen is displayed LOUISIANA MEDICAID Microsoft Internet Explorer File Edit View Favorites Tools Help Se Back Qysearh Favorites 3w mE Louisianaa ae Provider Logout HIPAA Information Center About Medicaid Provider Enrollment Instructions Provider Support Billing Information Provider Update Remittance Advice Index Pharmacy Prescribing Providers Current Newsletter and RA Helpful Numbers FAQ Useful Links Forms Files Home Change Password C
9. ID digits Recipient Last Name Recipient First Name l Recipient ID 13 digits Date of Service CCYYMMDD Return to Main Menu eee oo EDI UM LA WEB Web Application User Manual 19 of 30 UNISYS EDI Solutions Group 06 17 2003 2 Enter the values for each of the fields being sure to enter all mandatory fields Mandatory field titles are displayed in red Transaction Set Control Number Optional This is the STO2 field of the 270 transaction created and will be echoed back in the STO2 field of the 271 response message Use this as a tracking number to correlate inquiry to response Reference ID Optional This is the BHTO3 field of the 270 transaction created and will be echoed back in the BHTO3 field of the 271 response message Use this as a tracking number to correlate inquiry to response Provider Type Mandatory Select the provider type from the pull down menu 1 Person 2 Non person Entity This field will default to 1 Person Provider ID Mandatory Enter the 7 digit provider ID Recipient Last Name Mandatory Enter the Recipient s Last Name up to 35 letters Recipient First Name Mandatory Enter the Recipient s First Name up to 25 letters Recipient ID Mandatory Enter the 13 digit Recipient ID number Date of Service Mandatory Enter the Date of Service in the format CC
10. UNISYS Global Industries Louisiana Medicaid Management Information Systems LA MMIS User Manual for the Medicaid Eligibility Verification System MEVS Web Application 17 June 2003 Initial Release Version 1 0 EDI UM LA WEB Prepared by Unisys Corporation 600 Lynnhaven Parkway Suite 101 Virginia Beach Virginia 23452 This page intentionally left blank e UNISYS EDI Solutions Group 06 17 2003 Title Louisiana Medicaid Management Information Systems LA MMIS User Manual for the Medicaid Eligibility Verification System MEVS Web Application Number EDI UM LA WEB Issued Initial Release June 17 2003 Recertified Supersedes Contact Carilon Holbert Approved Neill Alford EDI Solutions Group Manager Signature Date LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS LA MMIS UsER MANUAL FOR THE MEDICAID ELIGIBILITY VERIFICATION SYSTEM MEVS WEB APPLICATION UNISYS CORPORATION EDI UM LA WEB Web Application User Manual 1 of 30 e UNISYS EDI Solutions Group 06 17 2003 Table of Contents A O N INTRODUCTION essc MA 4 INSTAEEATION 22 2 ctepoi excE AE aa Gu SEE nn ex 2E Eve GE SUC ne cx 2E CE EE ce SU E me eu EE CREE aaa Aa AE CREER DP ERa 4 MAIN MENU ACCESS x cexicik cei CX E ERCEERERERCXRAEEERCERREERAUKRREEERTERRERRRUKRRERERTRRRERBACRRR 4 MEVS INQUIRIES no IER eee ee epu see eee ene u eee scia atra seta aja ocira enhon eae erahnen aS 7 4 1 Inquire by Card Control Number
11. YYMMDD For example enter 20030409 for a service date of April 9 2003 3 When all fields have been entered click the Send Message button If any mandatory fields have not been entered an alert message will be displayed Click OK on the alert window and enter the mandatory field s EDI UM LA WEB Web Application User Manual 20 of 30 UNISYS 4 7 Inquire By Name and DOB E LOUISIANA MEDICAID Microsoft Internet Explorer Fie Edit View Favorites Tools Help EDI Solutions Group 06 17 2003 lel xi Back gt A A Asearch gFavortes meda C B SG 8 A Address Links Provider Logout HIPAA Information Center About Medicaid Provider Enrollment Instructions Provider Support Billing Information Provider Update Remittance Advice Index Pharmacy Prescribing Providers Current Newsletter and RA Helpful Numbers FAQ Useful Links Forms Files Home LOUISIADR sid ud Medicaid Eligibility Verification Web Application ELIGIBILITY INQUIRY By Card Control Number and DOB By Card Control Number and SSN By SSN and DOB By Recip ID and DOB By Recip ID and SSN By Recip ID and Name By Name and DOB By Name and SSN a il E B internet 1 Select the By Name and DOB hyperlink The following screen for this inquiry is displayed Reset Send Message Medicaid Elig
12. and DOB ssssesee 9 4 2 Inquire by Card Control Number and SSN sssss 11 4 3 Inquire by SSN and DOB ccccccccccceceeeeeeeeeeeeeeeeseseseeeseeeeeseseessessssssseseeess 13 4 4 Inquire by Recip ID and DOB cic pear xk Ce R eI ep EE ERE CHE E EREE EF rnt rope cedsenGsaxbeuwse 15 45 Inquire by Recip ID and 9S5INaseiicoeei pii Rae ppl e E p evpEU paupe 17 4 6 Inquire by Recip ID and Name sseeesssseeeeeemneeee 19 4 7 Inquire by Name and DOB cccccecccccceeeseeeeeeeeeceeeeeeesseeeeeeeeeeeeeeaeeeeess 21 4 8 Inquire by Name and SSN emere 23 VIEW THE RESPONSE areait ie sis Pee eH THE e Fek Fee abate Fey e Xy ak e Fey we eX EYE e PEE RD ee re 25 5 1 Basie ReSDOISB ratto irae co at adr ea qs db ee sls ANA aE 25 S Wald RESPONSE unde DERECHO n E DEDI Tut DR DDR DU mete melee mt 26 bo invalid RESPONSE mter ineo vet De CEEREEB e Ex EDREEE HU De EP D CERE E ES HE DUE EEDE 29 EDI UM LA WEB Web Application User Manual 2 of 30 e UNISYS EDI Solutions Group 06 17 2003 REVISION HISTORY CONTROLLED COPIES ISSUED BY EDI Solutions Group Revision Revision Description Approval Date Initial Release N Alford 06 17 2003 EDI UM LA WEB Web Application User Manual 3 of 30 e UNISYS EDI Solutions Group 06 17 2003 1 INTRODUCTION The purpose of the Medicaid Eligibility Verification System MEVS Web Application is to provide a way for small low volume provid
13. d an alert message will be displayed Click OK on the alert window and enter the mandatory field s EDI UM LA WEB Web Application User Manual 18 of 30 UNISYS 4 6 Inquire By Recip ID and Name E LOUISIANA MEDICAID Microsoft Internet Explorer Fie Edit View Favorites Tools Help EDI Solutions Group 06 17 2003 lel xi Bak gt A A Asearch gFavortes meda C B 5 3 8 A Address Links Provider Logout HIPAA Information Center About Medicaid Provider Enrollment Instructions Provider Support Billing Information Provider Update Remittance Advice Index Pharmacy Prescribing Providers Current Newsletter and RA Helpful Numbers LOUISIADR sid ud Medicaid Eligibility Verification Web Application ELIGIBILITY INQUIRY By Card Control Number and DOB By Card Control Number and SSN By SSN and DOB By Recip ID and DOB By Recip ID and SSN By Recip ID and Name By Name and DOB By Name and SSN FAQ Useful Links Forms Files Home ie PO E internet 1 Select the By Recip ID and Name hyperlink The following screen for this inquiry is displayed Medicaid Eligibility Verification Web Application Eligibility Inquiry by Recip ID amp Name Send Message Reset Transaction Set Control Number Reference ID Provider Type E Provider
14. der ID Mandatory Enter the 7 digit provider ID Recipient Last Name Mandatory Enter the Recipient s Last Name up to 35 letters Recipient First Name Mandatory Enter the Recipient s First Name up to 25 letters Social Security Number Mandatory Enter the 9 digit social security number in the format NNNNNNNNN Do not enter dashes enter only numbers Date of Service Mandatory Enter the Date of Service in the format CCYYMMDD For example enter 20030409 for a service date of April 9 2003 3 When all fields have been entered click the Send Message button If any mandatory fields have not been entered an alert message will be displayed Click OK on the alert window and enter the mandatory field s EDI UM LA WEB Web Application User Manual 24 of 30 e UNISYS EDI Solutions Group 06 17 2003 5 VIEW THE RESPONSE When all mandatory fields of the inquiry page have been filled and the Send Message button is clicked the message is sent to the MEVS system When the response is received it is parsed and displayed on the web browser Responses can be valid responses where the input message was correct and matches were found for provider and recipient in the database and recipient is eligible or they can be invalid responses where input message had errors provider and or recipient were not found in database or recipient is just not eligible The following pa
15. eb Application User Manual 30 of 30
16. ers who do not work with a switch vendor to query Medicaid Eligibility information The Web Application is used by selecting a way to enter inquiry entering the inquiry and viewing the response There are eight different ways to enter an inquiry Section 4 MEVS Inquiries shows an example of each query screen and describes the mandatory information needed to perform the query as well as any optional information that can be entered When all mandatory fields of the inquiry page have been filled and the Send Message button is clicked the message is sent to the MEVS or CSI system When the response is received it is parsed and displayed on the web browser Section 5 shows an example of a basic a valid and an invalid response After viewing the response the user may click the Return to Main Page button to return to the main page or click the Return to Main Menu hyperlink to return to the main menu and choose another option 2 INSTALLATION Instructions for installing the Web Application and Configuring the UNIX Minicomputer refer to Appendix A 3 MAIN MENU ACCESS The steps to access the main menu are as follows 1 Open a web browser and enter the URL for the Louisiana Medicaid main menu http www lamedicaid com The following screen will be displayed E Louisiana Medicaid Microsoft Internet Explorer E x File Edit View Favorites Tools Help Sepak gt Ol A Bsearch Favorites Meda 4 B 30A SA Address Li
17. field titles are displayed in red Transaction Set Control Number Optional This is the STO2 field of the 270 transaction created and will be echoed back in the STO2 field of the 271 response message Use this as a tracking number to correlate inquiry to response Reference ID Optional This is the BHTO3 field of the 270 transaction created and will be echoed back in the BHTO3 field of the 271 response message Use this as a tracking number to correlate inquiry to response Provider Type Mandatory Select the provider type from the pull down menu 1 Person 2 Non person Entity This field will default to 1 Person Provider ID Mandatory Enter the 7 digit provider ID Social Security Number Mandatory Enter the 9 digit social security number in the format NNNNNNNNN Do not enter dashes enter only numbers Subscriber Birth Date Mandatory Enter the Subscriber s Birth Date in the format CCYYMMDD For example enter 19620417 for a birth date of April 17 1962 Date of Service Mandatory Enter the Date of Service in the format CCYYMMDD For example enter 20030409 for a service date of April 9 2003 3 When all fields have been entered click the Send Message button If any mandatory fields have not been entered an alert message will be displayed Click OK on the alert window and enter the mandatory field s EDI UM LA WEB Web A
18. fier NM109 ID Code Value 54321 11234 Information Source Payer UNISYS LAMMIS Payor ID 610551 Information Receiver Provider MMIS TEST MD Service Provider Number 1111112 Contact Number 8006480790 Subscriber Insured or Subscriber SIMONS TAMMY C Member ID Number 5304008500701 EDI UM LA WEB Web Application User Manual 26 of 30 UNISYS EDI Solutions Group DMG02 Birthdate DMG03 Dependent Gender Code NM103 Date Time Qualifier Date Eligibility or Benefit Information Coverage Level Code Service Type Code Insurance Type Code Plan Coverage Description Eligibility or Benefit Information Coverage Level Code Service Type Code Insurance Type Code Plan Coverage Description Eligibility or Benefit Information Coverage Level Code Service Type Code Insurance Type Code Entity ID Code Last Name Org Name First Name Middle Name Name Suffix Contact Function Code Communication Number Qualifier Communication Number Eligibility or Benefit Information Coverage Level Code Service Type Code Insurance Type Code Entity ID Code Last Name Org Name 06 17 2003 19691020 Female Service 20021115 Benefit Description Individual Health Benefit Plan Coverage Medicaid 01ELIGIBLE FOR MEDICAID Benefit Description Individual Health Benefit Plan Coverage Medicaid 12PREFERRED LANGUAGE ENGLISH Services Restricted to Following Provider I
19. hange Account Info Provider Logout Help Provider Applications Area E H The application s listed below are for authorized use only Click on an application link to access the application Provider Applications Provider Demographics Restricted Provider Applications Clinical Drug Inquiry Medicaid Eligibility Verification System Document Provider Applications Area Date Modified 1 24 03 e B memet 7 Click the Medicaid Eligibility Verification System hyperlink The following screen is displayed EDI UM LA WEB Web Application User Manual 6 of 30 UNISYS EDI Solutions Group LOUISIANA MEDICAID Microsoft Internet Explorer lal x Fie Edit View Favorites Tools Help Back gt A A Asearch Gyravorites meda J B 5 I3 ER Address Links El Louis Provider Logout HIPAA Information Center About Medicaid Provider Enrollment Instructions Provider Support Billing Information Provider Update Remittance Advice Index Pharmacy Prescribing Providers Current Newsletter and RA Helpful Numbers FAQ Useful Links Forms Files Home Iani aid c ELIGIBILITY INQUIRY By Card Control Number and DOB By Card Control Number and SSN By SSN and DOB By Recip ID and DOB By Recip ID and SSN By Recip ID and Name By Name and DOB By Name and SSN Medicaid Eligibility Verificati
20. ibility Verification Web Application Eligibility Inquiry by Name amp DOB Transaction Set Control Number Reference ID ETT mann nnm Provider Type T Provider ID 7 digits Recipient Last Name l Recipient First Name Subscriber Birth Date CCYYMMDD Return to Main Menu Date of Service CCYYMMDD EDI UM LA WEB Web Application User Manual 21 of 30 UNISYS EDI Solutions Group 06 17 2003 2 Enter the values for each of the fields being sure to enter all mandatory fields Mandatory field titles are displayed in red Transaction Set Control Number Optional This is the STO2 field of the 270 transaction created and will be echoed back in the STO2 field of the 271 response message Use this as a tracking number to correlate inquiry to response Reference ID Optional This is the BHTO3 field of the 270 transaction created and will be echoed back in the BHTO3 field of the 271 response message Use this as a tracking number to correlate inquiry to response Provider Type Mandatory Select the provider type from the pull down menu 1 Person 2 Non person Entity This field will default to 1 Person Provider ID Mandatory Enter the 7 digit provider ID Recipient Last Name Mandatory Enter the Recipient s Last Name up to 35 letters Recipient First Name Mandatory Enter the Recipient s Fi
21. ierarchical Level Code Information Source EDI UM LA WEB Web Application User Manual 25 of 30 e UNISYS EDI Solutions Group 06 17 2003 To tell whether the response is a valid response or an invalid response look for either a set of AAA fields or a set of EB fields If any AAA fields are displayed then the response is invalid If any EB fields are displayed then the response is valid 5 2 Valid Response The following is an example of a valid response ACTUAL DATA MAY NEED TO BE SANITIZED The EB fields EBO1 EBO2 etc contain the eligibility information The fields before the first EB field verify the payer provider and recipient information that was entered The EB fields and the REF PER HSD etc fields that follow the EB fields explain the eligibility more fully Medicaid Eligibility Verification Web Application Field ID Field Title STO2 Transaction Set Control Number BHT03 Reference ID HLO3 Hierarchical Level Code NM101 Entity ID Code NM103 Last Name Org Name NM108 ID Code Qualifier NM109 ID Code HLO3 Hierarchical Level Code NM101 Entity ID Code NM103 Last Name Org Name NM108 ID Code Qualifier NM109 ID Code REFO1 Reference ID Qualifier REFO2 Reference ID HLO3 Hierarchical Level Code NM101 Entity ID Code NM103 Last Name Org Name NM104 First Name NM105 Middle Name NM108 ID Code Quali
22. k OK on the alert window and enter the mandatory field s EDI UM LA WEB Web Application User Manual 16 of 30 e UNISYS EDI Solutions Group 06 17 2003 4 5 Inquire By Recip ID and SSN Z LOUISIANA MEDICAID Microsoft Internet Explorer 18 xj Fie Edit View Favorites Tools Help Bak gt A A Asearch gFavortes meda C B 5 3 8 A Address Links Provider Logout HIPAA Information Center About Medicaid Provider Enrollment Instructions Provider Support Billing Information Provider Update Remittance Advice Index Pharmacy Prescribing Providers Current Newsletter and RA Helpful Numbers LOUISIADR sid ud Medicaid Eligibility Verification Web Application ELIGIBILITY INQUIRY By Card Control Number and DOB By Card Control Number and SSN By SSN and DOB By Recip ID and DOB By Recip ID and SSN By Recip ID and Name By Name and DOB By Name and SSN FAQ Useful Links Forms Files Home r3 PO E internet 1 Click the By Recipi ID and SSN hyperlink The following screen for this inquiry is displayed Medicaid Eligibility Verification Web Application Eligibility Inquiry by Recip ID amp SSN SendMessage Reset Transaction Set Control Number Reference ID l Provider Type Provider ID 7 digits Social Security Number Recipient ID 13 digits
23. l Date of Service CCYYMMDD Return to Main Menu EDI UM LA WEB Web Application User Manual 17 of 30 UNISYS EDI Solutions Group 06 17 2003 2 Enter the values for each of the fields being sure to enter all mandatory fields Mandatory field titles are displayed in red Transaction Set Optional This is the STO2 field of the 270 transaction created Control Number and will be echoed back in the STO2 field of the 271 response message Use this as a tracking number to correlate inquiry to response Reference ID Optional This is the BHTO3 field of the 270 transaction created and will be echoed back in the BHTO3 field of the 271 response message Use this as a tracking number to correlate inquiry to response Provider Type Mandatory Select the provider type from the pull down menu 1 Person 2 Non person Entity This field will default to 1 Person Provider ID Mandatory Enter the 7 digit provider ID Recipient ID Mandatory Enter the 13 digit recipient ID Social Security Mandatory Enter the 9 digit social security number in the format Number NNNNNNNNN Do not enter dashes enter only numbers Date of Service Mandatory Enter the Date of Service in the format CCYYMMDD For example enter 20030408 for a service date of April 9 2003 3 When all fields have been entered click the Send Message button If any mandatory fields have not been entere
24. lity of DHH E 4p Internet EDI UM LA WEB Web Application User Manual 4 of 30 e UNISYS EDI Solutions Group 06 17 2003 2 Click the Provider Login button on the left side the following security message will appear F Louisiana Medicaid Microsoft Internet Explorer AN 81 xl File Edit View Favorites Tools Help Back gt A A Asearch Gyravorites Bmedia lt 4 Ey 59 I3 ER Address Links zd Louie o Provider Login Notice to Pharmacv and Prescribina Providers HIPAA Information Center Yams d Alert J x About Medicaid Provider Enrollment i You are about to view pages over a secure connection ie Instructions Provider Support E E i Sa ees Any information you exchange with this site cannot be Prowder Units viewed by anyone else on the Web Remittance Advice Index Pharmacy Prescribing Providers Current Newsletter and RA Helpful Numbers FAQ Useful Links Inthe future do not show this warning Forms Files inks to numerous As you move throughout the site please note that we hav Home ysefulwebsites These sites are maintained independen 3 Click OK The following screen is displayed LOUISIANA MEDICAID Microsoft Internet Explorer File Edt View Favorites Tools Help Back gt A Qsearch Favorites media lt 4 D Gl 8 A Address Links LouiS sia ud ProviderLogout_ Provider Login E HIP
25. message Use this as a tracking number to correlate inquiry to response Reference ID Optional This is the BHTO3 field of the 270 transaction created and will be echoed back in the BHTO3 field of the 271 response message Use this as a tracking number to correlate inquiry to response Provider Type Mandatory Select the provider type from the pull down menu 1 Person 2 Non person Entity This field will default to 1 Person Provider ID Mandatory Enter the 7 digit provider ID Social Security Number Mandatory Enter the 9 digit social security number in the format NNNNNNNNN Do not enter dashes enter only numbers Card Control Number Mandatory Enter the 16 digit Card Control Number Date of Service Mandatory Enter the Date of Service in the format CCYYMMDD For example enter 20030409 for a service date of April 9 2003 Card Issue Date Mandatory Enter the Card Issue Date in the format CCYYMMDD For example enter 20030101 for a card issue date of January 1 2003 3 When all fields have been entered click the Send Message button If any mandatory fields have not been entered an alert message will be displayed Click OK on the alert window and enter the mandatory field s EDI UM LA WEB Web Application User Manual 12 of 30 UNISYS EDI Solutions Group
26. ndividual Professional Physician Other Provider MURPHY RACHAEL M MD Information Contact Telephone 9858097400 Services Restricted to Following Provider Individual Professional Physician Other Provider DICARLO EDI UM LA WEB Web Application User Manual 27 of 30 UNISYS NM104 NM105 NM107 PERO41 PERO3 PERO04 HSD01 EDI Solutions Group First Name Middle Name Name Suffix Contact Function Code Communication Number Qualifier Communication Number Eligibility or Benefit Information Coverage Level Code Service Type Code Insurance Type Code Entity ID Code Last Name Org Name First Name Middle Name Name Suffix Contact Function Code Communication Number Qualifier Communication Number Eligibility or Benefit Information Coverage Level Code Service Type Code Insurance Type Code Entity ID Code Last Name Org Name Contact Function Code Communication Number Qualifier Communication Number Eligibility or Benefit Information Coverage Level Code Service Type Code Insurance Type Code Quantity Qualifier 06 17 2003 RICHARD P MD Information Contact Telephone 5045685900 Services Restricted to Following Provider Individual Professional Physician Other Provider BERRY III CHARLES M MD Information Contact Telephone 5048337773 Services Restricted to Following Provider Individual Pharmacy O
27. nks e mne critt Provider Login Notice to Pharmacy and Prescribing Providers HIPAA Information Center About Medicaid Welcome to the Louisiana Medicaid Provider Support Center Provider Enrollment The Louisiana Department of Health and Hospitals and Unisys have created this Instructions website to make information more accessible to Medicaid providers Atthis online Provider Support location providers can access information ranging from how to enroll as a Medicaid Billing Information provider to directions for filling out a claim form Provider Update Remittance Advice Index In addition providers can have direct contact with the Unisys Field Analyst assigned Pharmacy tO their area or find information on provider training Select the Provider Support Prescribing Providers link in the table of contents on the left side of the screen to find your representative Current Newsletter and RA Helpful Humbers FAQ Useful Links Some questions you might have are already answered on our FAQ page Visit it by using the link located on the index to your left Click on any of these items to learn more about the Louisiana Medicaid Program Forms Files As you move throughout the site please note that we have included links to numerous Home Useful websites These sites are maintained independently of the Department of Health and Hospitals Availability of these sites is not the responsibi
28. o correlate inquiry to response This is the BHTO3 field of the 270 transaction created and will be echoed back in the BHTO3 field of the 271 response message Use this as a tracking number to correlate inquiry to response Select the provider type from the pull down menu 1 Person 2 Non person Entity This field will default to 1 Person Enter the 7 digit provider ID Enter the 16 digit Card Control Number Enter the Subscriber s Birth Date in the format CCYYMMDD For example enter 19620417 for a birth date of April 17 1962 Enter the Date of Service in the format CCYYMMDD For example enter 20030409 for a service date of April 9 2003 Enter the Card Issue Date in the format CCYYMMDD For example enter 20030101 for a card issue date of January 1 2003 3 When all fields have been entered click the Send Message button If any mandatory fields have not been entered an alert message will be displayed Click OK on the alert window and enter the mandatory field s EDI UM LA WEB Web Application User Manual 10 of 30 e UNISYS EDI Solutions Group 06 17 2003 4 2 Inquire By Card Control Number and SSN Z LOUISIANA MEDICAID Microsoft Internet Explorer lej xl Fie Edit View Favorites Tools Help e8k gt A Qsearch sgFavortes meda D 5 I3 I A Address Links i Provider Logout HIPAA Information Center About Medicaid Provider Enrollment
29. on Web Application C lel 4 MEVS INQUIRIES MEVS inquiries can be requested using eight different methods Requests can be entered using the following criteria B qp internet EDI UM LA WEB Web Application User Manual 06 17 2003 7 of 30 e UNISYS EDI Solutions Group 06 17 2003 Card Control Number and DOB Card Control Number and SSN SSN and DOB Recip ID and DOB Recip ID and SSN Recip ID and Name Name and DOB Name and SSN Each choice is an alternate method of identifying a recipient The response to each of the different inquiries for the same recipient will be the same The following paragraphs show example screens of each of the different inquiries EDI UM LA WEB Web Application User Manual 8 of 30 UNISYS 4 1 EDI Solutions Group 06 17 2003 Inquire By Card Control Number and DOB la xi E LOUISIANA MEDICAID Microsoft Internet Explorer Fie Edit View Favorites Tools Help Bak gt Q A Qsearch gFavortes meda D 5 I3 H g Address Links X Provider Logout HIPAA Information Center About Medicaid Provider Enrollment Instructions Provider Support Billing Information Provider Update Remittance Advice Index Pharmacy Prescribing Providers Current Newsletter RA Helpful Numbers FAQ Useful Links Forms Files Home LOUISIADR aid ud Medicaid Eligibility Verification Web Application
30. pplication User Manual 14 of 30 UNISYS 44 Inquire By Recip ID and DOB E LOUISIANA MEDICAID Microsoft Internet Explorer File Edit View Favorites Tools Help EDI Solutions Group 06 17 2003 12 xl Back gt A Asearch fayravorites QjMeda C B GB 8 A Address Links Z Provider Logout HIPAA Information Center About Medicaid Provider Enrollment Instructions Provider Support Billing Information Provider Update Remittance Advice Index Pharmacy Prescribing Providers Current Newsletter RA Helpful Numbers FAQ Louis anm id Medicaid Eligibility Verification Web Application ELIGIBILITY INQUIRY By Card Control Number and DOB By Card Control Number and SSN By SSN and DOB By Recip I Q By Recip ID and SSN By Recip ID and Name By Name and DOB By Name and SSN Useful Links Forms Files Home 3 FOIE fep internet 1 Click the By Recip ID and DOB hyperlink The following screen for this inquiry is displayed Medicaid Eligibility Verification Web Application Eligibility Inquiry by Recip ID amp DOB Send Message Reset Transaction Set Control Number Reference ID Provider Type x Provider ID 7 digits Recipient ID 13 digits Subscriber Birth Date CCYYMMDD Date of Service CCYYMMDD Return to
31. ragraphs provide an example of each of the responses 5 1 Basic Response The following is an example of a basic response to a MEVS inquiry The title Medicaid Eligibility Verification Web Application Response is displayed at the top of the page Below it is a table of the following values Field ID Field Title and Value The Field ID is the X12 field identification of the field being displayed Not all fields in the X12 response are displayed Only the fields that will display information about the recipient s eligibility or fields that help explain subsequent fields are displayed The Field Title is the X12 title of that field The Value is either the actual value of the field or an enumerated value of an identifier data element For example the actual value of the STO2 field below is 54321 The actual value of the HLO3 field is 20 but because it is an X12 identifier data element its values are documented in the X12 data element dictionary So the web application can display what the code 20 means which is Information Source If Transaction Set Control Number and or Reference ID were entered in the inquiry the same numbers will be echoed back in the response See the values 54321 for Transaction Set Control Number and 11234 for reference id below Medicaid Eligibility Verification Web Application Response Field ID Field Title Value STO2 Transaction Set Control Number 54321 BHT03 Reference ID 11234 HLO3 H
32. rst Name up to 25 letters Subscriber Birth Date Mandatory Enter the Subscriber s Birth Date in the format CCYYMMDD For example enter 19620417 for a birth date of April 17 1962 Date of Service Mandatory Enter the Date of Service in the format CCYYMMDD For example enter 20030409 for a service date of April 9 2003 3 When all fields have been entered click the Send Message button If any mandatory fields have not been entered an alert message will be displayed Click OK on the alert window and enter the mandatory field s EDI UM LA WEB Web Application User Manual 22 of 30 e UNISYS EDI Solutions Group 06 17 2003 4 8 Inquire By Name and SSN LOUISIANA MEDICAID Microsoft Internet Explorer 18 xj Fie Edit View Favorites Tools Help Back gt A A Asearch gFavortes meda C B SG 8 A Address Links LOUISIADR sid ud Provider Logout HIPAA Information Center About Medicaid Provider Enrollment Instructions Provider Support Billing Information Provider Update Current Hewsletter and RA Helpful Humbers FAQ Remittance Advice Index By Recip ID and DOB Pharmacy Prescribing By Recip ID and SSN Providers By Recip ID and Name Medicaid Eligibility Verification Web Application ELIGIBILITY INQUIRY By Card Control Number and DOB By Card Control Number and SSN By SSN and DOB
33. ther Provider THE MEDICINESHOPPE PHARMACY Information Contact Telephone 9858923211 Benefit Description Individual Professional Visit Office Point of Service POS Units EDI UM LA WEB Web Application User Manual 28 of 30 e UNISYS EDI Solutions Group 06 17 2003 HSD02 Benefit Quantity 0000 Return to Main Page Return to Main Menu The page can be printed by clicking the printer icon on the web browser NOTE The privacy of the recipient should be safeguarded To enter another inquiry of the same type Name and DOB for instance click the Return to Main Page button To enter an inquiry of a different type than the last inquiry click the Return to Main Menu hyperlink 5 3 Invalid Response An invalid response could be caused by incorrect data being entered or even if the data is entered correctly the recipient may not be eligible The following is an example of an invalid response ACTUAL DATA MAY NEED TO BE SANITIZED The AAA fields explain why the inquiry was invalid AAAO1 is the valid request indicator If the error was in the request this value will be No If the request was valid however the transaction was rejected this value will be Y es AAAO03 is the Reject Reason Code If an X12 syntax error occurred this value will be Unable to Respond at Current Time AAAO4 is the Follow up Action Code This value will inform the user whether to correct the request and
Download Pdf Manuals
Related Search