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eMEVS User Manual - Louisiana Medicaid

1. Hospt ingot Oupatunt Emengency Oca Lugent Care Please Mote Individual Corm age level applies to all benelits Request Reference Humber 137761253520 130376053105 Respomte FRelenence Humber 201303260000005 Trangaetum rom an O27 13 ad ra 11 05 CT Leeper md Note the Search Type This will vary depending on the type of search you made see 3 0 Atypical providers are shown Louisiana Medicaid ID number not the NPI Eligibility and Deductible information for the specified recipient on the specified Plan Date is shown here If other insurance is present on the Medicaid file for the specified recipient on the specified Plan Date it is shown here Please refer to 4 1 below for clarification regarding Co Insurance Deductible and Co Payment Date Revised 11 12 2015 18 eMEVS Application User Manual 4 1 Important 5010 Changes to Response Data 4 1 1 Deductible Co Insurance Co Pay The transition from National 4010 specifications for electronic responses to 5010 specifications mandated changes to MEVS responses One of the changes requires that all companies include information concerning patient deductible co insurance co pay in the eligibility response These new fields appear in the response for Medicaid coverage Since deductible co insurance co pay does not apply for Medicaid recipients
2. 10 2 9 Searchby SON and DOB cnnan 11 3 6 Inquiry by Recipient ID and DOB 12 3 7 Inquiry by Recipient ID and SSN 13 3 8 Inquiry by Recipient ID and Name 14 3 9 Inquiry by Recipient Name and 55 _ 15 3 10 Inquiry by Recipient Name and DOB 16 SEARCH RESPONSE J J J J NE SEES 18 4 1 Important 5010 Changes to Response Data 19 4 1 1 Deductible Co Insurance Co Pay 19 4 1 2 Additional Third Party Liability Information 20 4 2 X Behavioral Health Transition into Bayou Health 2 0 Changes 21 42 1 Response MessSag EE eeu ex deux cure ee eee 21 4 2 2 Health Benefit Plan Coverage 22 APPENDIX A INTERNET EXPLORER WEB BROWSER FUNCTIONS 27 5 1 Web Browser Features 27 APPENDIX B EMEVS SWIPE CARD CROSSWALK PROPRIETARY SWIPE CARD MESSAGES HIPAA STANDARDIZED MESSAGES
3. 29 APPENDIX C DISEASE MANAGEMENTT 31 rs EM iei ssp 31 7 2 FOW died EIU 31 COME up 32 7 9 1 Female WIR Call Celsus deem cadena a uu kau RR RR 32 7 32 Male With Can Bl u REN Fa Rb Fc E RR KI e CR 34 TA Closing the WIN OW icupuasiussspasssasupasapssasasastaqasassqiassapssupaqanspunspasss 34 To Pri t ioapabililieg uuu ced 35 35 APPENDIX D SPECIAL ELIGIBILITY RESPONSES 37 M ca e Pario uu a uen 37 8 2 Case Manager ERR 38 Date Revised 11 12 2015 IV eMEVS Application User Manual Date Revised 11 12 2015 V eMEVS Application User Manual 1 0 OVERVIEW The Electronic Medicaid Eligibility Verification System eMEVS Web Application provides a secure web based tool for low volume providers who do not work with a switch vendor to verify Medicaid eligibility information The application is accessible to all providers who have a computer with Internet access using a recent version of either Netscape Navigator or Internet Explorer browser software Providers must establish a valid online account with Louisiana Medicaid complete with a valid login ID and password in order to access the web based eMEVS tool See Attachment C Provider Enrollment Instructions for instructions on how to secure a login ID and password Once the Provider Ap
4. HPI 0011001100 shown Telephone 337 438 5747 Louisiana Medicaid ID number not the Subscriber Information NPI Hame Member ID Hani Date of Birth Sex Male Health Benefit Plan Coverage Benefit Covet age Level Insurance Type Plan Coverage Deseripiion Ave Coverage beach aad for Mecdkcsid on Date of Samea Benefit Description Recipient EPSOT Ebgible Dezcripbon Preterred Erg gement Provider Hame Comwerage Level Serubce Type Telephone MEDICAL RESOURCES amp OUDANCE incizidual Beneit Plan Coverage 337 363 4998 Primary Care Provider Provider Hamme VAAL LINED Telephone 337 783 8215 Coverage Level Service Insurance Bsd Plan Coverage Descrigtion LOLEANA COMMUNT Y CARE PROGRAM Messages COMMUNITY CARE MUST AUTHORIZEPROVIDE SERVICES EXCEPT EXEMPT SERVICES AS SPECIFED BY THE COMMUNT Y CARE PROGRAM Request Reference Humber Response Reference Hurnber ZUODEUOAQSDOT 5134 Date Revised 11 12 2015 38 eMEVS Application User Manual 8 3 PACE The eMevs application was modified to accommodate the return of the new PACE eligibility information If the Recipient Type Case is 100 or 101 then the Recipient is a PACE recipient and the following is returned O1ELIGIBLE FOR CAPITATED PAYMENTS ONLY Date Revised 1
5. Physician Visit Office Urgent Care MEDICAID Benefit Co Pay is 0 for In Plan Network and Out of Plan Network Chiropractic Hospital Hospital Inpatient Hospital Outpatient Emergency Services Professional Physician Visit Office Urgent Care Case 7 ICF DD Children Enroll Typez B Health Benefit Plan Coverage Benefit Service Type Code Active Coverage Health Benefit Plan Coverage Medicaid Deductible Health Benefit Plan Coverage Medicaid Benefit Description Long Term Care Medicaid Benefit Description Health Benefit Plan Coverage Medicaid Managed Care Coorainator Specialized Behavioral Medicaid Health Care Active Coverage Medicaid Co Insurance Medicaid Co Payment Medicaid Insurance Type Plan Coverage Description Eligible for Medicaid on Plan Date Plan Begin Date 09 01 2011 Health Plan Base Deductible is SO for In Plan Network and Out of Plan Network PREFERRED LANGUAGE ENGLISH BAYOU HEALTH PLAN Managed Care AMERIHEALTH CARITAS LOUISIANA Organization Telephone 888 756 0004 Eligible for Medicaid on Plan Date Medical Care Chiropractic Dental Care Hospital Hospital Inpatient Hospital Outpatient Emergency Services Pharmacy Professional Physician Visit Office Vision Optometry Behavioral Health Urgent Care MEDICAID Benefit Co Insurance is 096 for In Plan Network and Out of Plan Network Chiropractic Hospital Hospital Inpatient Hospital Outpatient Emergency Services
6. 1 3 p 14 corrected formatting error on table p 26 replaced screenshots Appendix C corrected page references p 32 All per LaLauni Williams Corrected Revision History and a typo on p 34 per 5 LaLauni Williams Overhauled main document for NPI Appendix C updated for NPI screenshots in Appendix E updated for NPI 6 27 08 Updates per DHH Reviewers Corrected typos in 2 0 R Sheehan added notes in each Inquiry Fields table for atypical providers 3 0 provided cross reference to 3 1 2 added text and arrow for atypical providers and re aligned text and arrows in 4 0 added text and arrow for atypical providers in 9 2 Unisys corrections edited the 2 paragraph of 1 0 for clarity Corrected typo in 4 0 corrected page references and a ounctuation error in 7 0 6 30 08 Reformatted pagination 2 0 3 0 5 0 and 7 0 R Sheehan corrected typo in 7 0 7 1 08 Corrected typos in 8 0 R Sheehan 12 17 2008 Replaced Section 2 0 reformatted in accordance with R Sheehan new User Manual standard Removed Appendix titled Louisiana Medicaid Provider Online Accounts Provider Enrollment Instructions 07 12 2010 New logos Unisys Molina 7106 R Sheehan 01 01 2012 The application was modified to accommodate 5010 H Borazanci EDI protocols the following sections of the user and manual were changed accordingly 1 0 3 0 3 3 3 4 Sheehan 3 5 3 6 3 7 3 8 3 9 3 10 Updated screenshots for 3 2 2 4 0 8 1 and 8 2
7. Application Navigation Menu Search Response PrintFriendly Main Menu Help IMPORTANT DO HOT use the BACK browser button please use the navigation menu Note For Technical Support Please Contact 877 598 8753 Note For Eligibility Information Support Please Contact 473 2783 or dran 924 5040 Note The date field formats have changed enter date in MM DD YYYY form NOTE CMS REGULATIONS LIMIT PROVIDING RECIPIENT ELIGIBILITY OLDER THAN THE ee CURRENT 12 MONTHS Search By I ID and Name Clear Screen Provider Name KEC Provider ID IMPORTANT The following field is only available to Internal Providers Target Server H Entity Type Person Recipient ID 13 Digit Number Recipient Last Name First Name sufix Plan Date E mm dd yyyy Note Required fields are in red Submit Enter the values for each of the search fields except for those 1 Provider Name and which are already filled out All fields but the Suffix are required as indicated by the note at the bottom of the screen Recipient ID and Name Inquiry Fields Field Name Field Description Provider Name The first 18 characters of the provider s last name is filled in by the application The 10 digit National Provider Identifier of the provider whose login process has been authenticated is filled in by the application Note An atypical provider sees the appropriately labeled 7 digit Louisiana Medicaid ID not the NPI
8. Enter the 13 digit Recipient ID of the recipient for whom ou want eligibility verification on the Medicaid eligibility card eee en on the Medicaid eligibility card Enter the Recipient s Suffix name up to 3 letters seen on the Medicaid eligibility card not required Plan Date Enter the actual or planned date of service in the format MM DD YYYY For example enter 04 09 2008 for a service date of April 9 2008 Alternatively use the calendar function to enter the date When all the fields have been entered select the Submit button If any required fields have not been completed or are entered with invalid data an error message will be displayed see 3 2 2 Make the appropriate corrections and re submit the search A sample response is provided in 4 0 Date Revised 11 12 2015 14 eMEVS Application User Manual 3 9 Inquiry by Recipient Name and SSN Medicaid Eligibility Verification System Web Application Havigation Menu Search Response PrintFriendly Main Menu Help IMPORTANT DO HOT use the BACK browser button please use the navigation menu Note For Technical Support Please Contact 877 598 8753 Note For Eligibility Information Support Please Contact 800 473 2783 or 225 924 5040 Note The date field formats have changed enter date in MM DD YYYY format NOTE CMS REGULATIONS LIMIT PROVIDING RECIPIENT ELIGIBILITY OLDER THAN THE MOST CURRENT 12 MONTHS Search By Recipient Name and SSN Cle
9. HEALTH PLAN Health Care Managed Care AMERIHEALTH CARITAS LOUISIANA Organization Telephone 888 756 0004 Managed Care Coordinator Dental Care Medicaid DENTAL BENEFITS PLAN MANAGER Benefit Begin 07 01 2014 Payer MCNA INSURANCE COMPANY Telephone 855 701 6262 https portal MCNA net Active Coverage Medicaid Eligible for Medicaid on Plan Date Medical Care Chiropractic Dental Care Hospital Hospital Inpatient Hospital Outpatient Emergency Services Professional Physician Visit Office Vision Optometry Behavioral Health Urgent Care Co Insurance Medicaid MEDICAID Benefit Co Insurance is 096 for In Plan Network and Out of Plan Network Chiropractic Hospital Hospital Inpatient Hospital Outpatient Emergency Services Professional Physician Visit Office Urgent Care Case 9 Medicare QMB Only Exluded no changes Health Benefit Plan Coverage Benefit Service Type Code Insurance Type Plan Coverage Description Inactive Health Benefit Plan Coverage Medicaid Not Eligible for Medicaid on Plan Date Active Coverage Health Benefit Plan Coverage Qualified Medicare Beneficiary Benefit Begin 04 01 2008 ELIG PAY OF DED CO INS COVD BY MCARE Other or Additional Payor Health Benefit Plan Coverage Medicare Part A Benefit Begin 02 01 1995 Other or Additional Payor Health Benefit Plan Coverage Medicare Part B Benefit Begin 02 01 1995 Benefit Description Health Benefit Plan Coverage Medicaid PREFERRED LANGUAGE ENGLISH Please
10. Last test 11 17 2003 Recommended next test 11 17 2004 Guide to Clinical Preventive Services 2nd Edition 1996 Report to the U S Preventive Services Task Force American Cancer Society Guidelines for the cancer related checkup update 1993 American Lirological Association and College of Radiology Print Screen button here Exit this screen To view additional clinical data for this patient click here to qo to e CDI electronic Clinical Data Inquiry 225 237 3370 7 4 Closing the Window Users may close the pop up window by either clicking the button at the top right of the pop up window or clicking the Exit this screen button S Clinical Practice Guidelines Reminder for Web Pa erventions considered and recommended for the Periodic Health Examination general population Our LaMedicaid clinical database reveals when the last test interventi below were performed and when the next test intervention is due for 1 Prostate Specific Antigen Test PSA Test Recommendation perform annually Years 50 and older Last test Mo paid Medicaid claims found Recommended next test As soon as clinically possible 2 Total Blood Cholesterol Measurement Test Recommendation perform annually Years 45 65 Last test No paid Medicaid claims found Recommended next test As soon as clinically possible 3 Fecal Occult Blood Test FOBT and or Sigmoidoscopy Recommendation perform annually Years 25 and olde
11. Note Individual coverage level applies to all benefits Date Revised 11 12 2015 26 eMEVS Application User Manual 5 0 APPENDIX A INTERNET EXPLORER WEB BROWSER FUNCTIONS 5 1 Web Browser Features Prior to initial use of the eMEVS Web Application the web browser setup must be configured This will ensure that the latest updates to the eMEVS application are displayed to the user Using a web browser such as Internet Explorer v4 0 or higher will ensure this 1 Select the Tools menu selection Select the Internet Options selection At the General Tab page under the Temporary Internet Files section Select the Settings button 4 Atthe Settings page Select the Every visit to the page radio button 5 Select the OK button on the Settings page 6 Select the OK button on the Internet Options page The following are examples of the type of Web browser capabilities that are available during a CSI Web User Screens session Back The Web browser keeps track of screens displayed in a linear sequence Selecting the Back button returns the user to the previously displayed page in this sequence When the user reaches the beginning point in this linear list of displayed screens the Back button becomes inactive Forward The Web browser keeps track of screens displayed in a linear sequence The Forward button remains inactive until the Back button is selected When the Back button has been selected the Forward button bec
12. Professional Physician Visit Office Urgent Care MEDICAID Benefit Co Pay is 0 for In Plan Network and Out of Plan Network Chiropractic Hospital Hospital Inpatient Hospital Outpatient Emergency Services Professional Physician Visit Office Urgent Care Date Revised 11 12 2015 25 eMEVS Application User Manual Case 8 Medicare Dual Enroll Type B Health Benefit Plan Coverage Benefit Service Type Code Insurance Type Plan Coverage Description Active Coverage Health Benefit Plan Coverage Medicaid Eligible for Medicaid on Plan Date Plan Begin Date 01 01 2007 Deductible Health Benefit Plan Coverage Medicaid Health Plan Base Deductible is SO for In Plan Network and Out of Plan Network Deductible Health Benefit Plan Coverage Medicaid Health Plan Remaining Deductible is 0 for In Plan Network and Out of Plan Network Benefit Description Health Benefit Plan Coverage Qualified Medicare Beneficiary Benefit Begin 03 01 2006 ELIG PAY OF DED CO INS COVD BY MCARE Other or Additional Payor Health Benefit Plan Coverage Medicare Part A Benefit Begin 01 01 2005 Other or Additional Payor Health Benefit Plan Coverage Medicare Part B Benefit Begin 01 01 2005 Other or Additional Payor Health Benefit Plan Coverage Other Eligible for Medicare Part D Benefit Begin 01 01 2011 Benefit Description Health Benefit Plan Coverage Medicaid PREFERRED LANGUAGE CANTONESE Managed Care Coordinator Specialized Behavioral Medicaid BAYOU
13. Submit Enter the values for each of the search fields except for those 1 Provider Name and which are already filled out All fields but the Suffix are required as indicated by the note at the bottom of the screen Recipient Name and SSN Inquiry Fields Field Name Field Description Provider Name The first 18 characters of the provider s last name is filled in by the application The 10 digit National Provider Identifier of the provider whose login process has been authenticated is filled in by the application Note An atypical provider sees the appropriately labeled 7 digit Louisiana Medicaid ID not the NPI on the Medicaid eligibility card on the Medicaid eligibility card Enter the Recipient s Suffix name up to 3 letters as seen on the Medicaid eligibility card not required Date of Birth Enter the recipient s Birth Date in the format MM DD YYYY For example enter 04 17 1962 for a birth date of April 17 1962 Alternatively use the calendar function to enter the date see 3 2 1 Plan Date Enter the actual or planned date of service in the format Date Revised 11 12 2015 16 eMEVS Application User Manual Recipient Name and SSN Inquiry Fields Field Name Field Description MM DD YYYY For example enter 04 09 2008 for a service date of April 9 2008 Alternatively use the calendar function to enter the date When all the fields have been entered select the Submit button If any
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15. date see 3 2 1 Plan Date Enter the actual or planned date of service in the format MM DD YYYY For example enter 04 09 2008 for a service date of April 9 2008 Alternatively use the calendar function to enter the date When all the fields have been entered select the Submit button If any required fields have not been completed or are entered with invalid data an error message will be displayed see 3 2 2 Make the appropriate corrections and re submit the search A sample response is provided in 0 Date Revised 11 12 2015 9 eMEVS Application User Manual 3 4 Search by CCN and Social Security Number SSN Medicaid Eligibility Verification System Web Application Havigation Menu Search Response PrintFriendly Main Menu Help IMPORTANT DO NOT use the BACK browser button please use the navigation menu Note For Technical Support Please Contact 877 598 8753 Note For Eligibility Information Support Please Contact 800 473 2783 or 225 924 5040 Note The date field formats have changed enter date in MM DD YYYY forma CMS REGULATIONS LIMIT PROVIDING RECIPIENT ELIGIBILITY OLDER THAN THE MOST CURRENT 12 MONTHS Search By Card Control Number and SSN Clear Screen Provider Name DHH EXEC MGMT Provider ID IMPORTANT The following field is only available to Internal Providers Target Server Saavik Entity Person Control Number 16 Digit Number Social Security Num
16. eMEVS web based application provides logical user friendly error messages in response to either a required field containing erroneous or incomplete information or where a required field has been left blank Error messages indicate exactly which required field must be corrected or completed as well as the exact number and or type of character that must be entered into that field A typical error message is displayed below Charge Pay woodi Change Accoont lout Melp Medicaid Eligibility Verification System V eb Application Navigation Menu icai Pespoese feo TLEPORTAAT OO NOT use De LACK trowser button please use Note for Technica oco lt Contec t 877 598 8753 Rote in 2 Note The dete fiels for Search Criteria Search Recigsort O Cate of Ore Pins Cote Error Sutbycriborlesured Net Found Please Correct and Resubenk Request Referee yurroec 12 2M 42000046 2112219 Response Pefeceece 0541223423 Date Revised 11 12 2015 eMEVS Application User Manual 3 3 Search by Card Control Number CCN and Date of Birth DOB Medicaid Eligibility Verification System Web Application Navigation Menu Search Response PrintFriendly Main Menu Help IMPORTANT DO HOT use the BACK browser button please use the navigation menu Note For Technical Support Please Contact 877 598 8753 Note For Eligibility Information Support Please Conta
17. is patient click here to qo to e CDI 225 237 3370 1 1 ee k ee ee ee ee xE mh ee m mtcr 2 __ 7 6 Notes 1 Pop up blockers must be disabled on the user s machine or the pop up screen will not appear 2 If you navigate to e CDI from the pop up see below and then search for e CDI information in the newly spawned screen the pop up will not appear again from within e CDI Why Because users will already know that the patient had disease information available 3 The pop up that is displayed by both the eMEVS and eCDI applications is the same for both applications Since the applications share the pop up code objects the pop up that is displayed is exactly the same between the two applications 4 If the Recipient being queried is found to have more than one type of disease as defined by the following categories a Diabetes b Cancer Then both pop ups will appear in succession One disease pop up will appear Once the first pop up is closed then the second pop up will appear 5 The pop up window that is shown is a modal dialog window This means that the user will not be able to continue working within the eMEVS or eCDI applications unless they dismiss close the dialog first Date Revised 11 12 2015 35 eMEVS Application User Manual amp 3 Clinica
18. required fields have not been completed or are entered with invalid data an error message will be displayed see 3 2 2 Make the appropriate corrections and re submit the search A sample response is provided in Date Revised 11 12 2015 17 eMEVS Application User Manual 4 0 Search Response When eMEVS locates the recipient for whom you are seeking eligibility report similar to the one shown below is displayed The report is divided by Search Criteria Provider Information oubscriber Information and Health Benefit Plan Coverage Note If there is no Managed Care Coordinator listed for the Plan Coverage Description Medical Care or Specialized Behavioral Health Care claims should be sent to Molina Medicaid Solutions Change Pawn Cage docu ka a Lepaa Medicaid Eligibility Verification System V eb Application Wienia kearrh Be oonas Poetry Maine eiu IESPORTANT 1 then Pe Bote For Supo Pe WB Hole Poe U 45 infer tee Sewer Paste Con taz i ooo Bober T mats hao E ch npesg exper dat mo TE an eedem Search D and Type Subscriber Information Provider Information Name Doe ATES Prowides DHH Exec Mgt Subscriber ID HP Date of Birth 997909909 Submimer ID 450000 Ferial 2013 Drive Towr
19. the different cases of Health Benefit Plan Coverages and how they are depicted in the eMEVS response Case 1 BYU Full Medical and BH Enroll Type P not a CSoC Child Health Benefit Plan Coverage Benefit Service Type Code Active Coverage Health Benefit Plan Coverage Medicaid Deductible Health Benefit Plan Coverage Medicaid Benefit Description Health Benefit Plan Coverage Medicaid Managed Care Coordinator Medical Care Medicaid Managed Care Coordinator Specialized Behavioral Medicaid Health Care Managed Care Coordinator Dental Care Medicaid Active Coverage Medicaid Co Insurance Medicaid Co Payment Medicaid Please Note Individual coverage level applies to all benefits Insurance Type Plan Coverage Description Eligible for Medicaid on Plan Date Plan Begin Date 02 01 2015 Health Plan Base Deductible is 0 for In Plan Network and Out of Plan Network PREFERRED LANGUAGE ENGLISH BAYOU HEALTH PLAN PHARMACY PBM IS PERFORMRX Managed Care AMERIHEALTH CARITAS LOUISIANA Organization Telephone 888 756 0004 BAYOU HEALTH PLAN Managed Care AMERIHEALTH CARITAS LOUISIANA Organization Telephone 888 756 0004 DENTAL BENEFITS PLAN MANAGER Payer MCNA INSURANCE COMPANY pe 855 701 6262 https portal MCNA net iii for Medicaid on Plan Date Medical Care Office Vision Optometry Behavioral Heatlh Urgent Care MEDICAID Benefit Co Insurance ts 0 for In Plan Network and Out of Plan Network Chiropractic
20. 1 12 2015 39
21. 4 5040 Note The date field formats have changed enter date in MM DD YYYY format prohibited by the Louisiana Department of Health and NOTE CMS REGULATIONS LIMIT PROVIDING RECIPIENT ELIGIBILITY OLDER THAN THE MOST CURRENT 12 MONTHS Hospitals Search By Card Control Number and DOB Clear Screen Provider Name DHH EXEC MGMT Provider ID 1413135 IMPORTANT The following field is only available to Internal Providers Target Server Saavik Entity Type Person Card Control Number 16 Digit Number DateOfBirh Plan Date E mm dd yyyy Note Required fields are red Submit Date Revised 11 12 2015 3 eMEVS Application User Manual 3 0 USING THE eMEVS APPLICATION Inquiries in eMEVS can be requested using eight different methods provided in a pull down menu in the Search By field 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 All mandatory or required fields are noted in red Providers must select the Submit button to complete each inquiry Card Control Number and DOB jr Card Control Number DOB Card Control Number and SSN SSH and DOB Recipient ID and DOB Recipient ID and SSH Recipient ID and Name Recipient and SSH Recipient and Requests can be entered using the following criteria Card Control Number and DOB Card Contro
22. Bayou Health initiative Screenshot in 4 0 updated 04 15 2013 Bayou Health display data modified Screenshot and H Sheehan text in 4 0 updated Added 4 1 Replaced screenshot in 3 1 4 Added clarification of Date of Service and Plan Date in 3 2 1 11 12 2015 Added section 4 2 Behavioral Health Transition into 10032 J Lavigne Bayou Health 2 0 Changes as per LIFT 10032 Date Revised 11 12 2015 eMEVS Application User Manual 4 0 5 0 6 0 7 0 8 0 TABLE OF CONTENTS OVERVIEW 1 ACCESSING THE APPLICATION 2 USING THE EMEVS APPLICATION eee eere nnn nnne 4 3 1 Navigation Menu for eMEVS 4 3 1 1 eMEVS Navigation Menu Links 5 S EC goi DE 5 3 13 5 9 1 4 IPHDLEHenDGOIyuieccesisesoankusisxsDas E 6 MESE Bui I a 7 J 0 TID uuu Z 7 3 2 Other Important Features to Know 7 32 1 Datesand Calendal as tiu u unn 7 2 2 2 MeSsSsag S aa Susu maaan tasta 8 3 3 Search by Card Control Number CCN and Date of Birth DOB 9 3 4 Search by CCN and Social Security Number SSN
23. D Y HOTE CMS REGULATIONS LIMIT PROVIDING m ies PUE OLDER THAN THEI e CURRENT 12 MONTHS Search By Recipient ID ID and DOB Clear Screen Provider Name DHH EXE GMI Provider ID IMPORTANT The following field is only available to Internal Providers Target Server Saavik Entity Person Recipient ID 13 Digit Number Date Of Birth EB mm da yyyy Plan Date E mm dd yyyy Note Required fields are in red Submit Enter the values for each of the search fields except for those i e Provider Name and which are already filled out All fields are required as indicated by the note at the bottom of the Screen Recipient ID and DOB Inquiry Fields Field Name Field Description Provider Name The first 18 characters of the provider s last name is filled in by the application The 10 digit National Provider Identifier of the provider whose login process has been authenticated is filled in by the application Note An atypical provider sees the appropriately labeled 7 digit Louisiana Medicaid ID not the NPI Enter the 13 digit Recipient ID of the recipient for whom you want eligibility verification Date of Birth Enter the recipient s Birth Date in the format MM DD YYYY For example enter 04 17 1962 for a birth date of April 17 1962 Alternatively use the calendar function to enter the date see 3 2 1 Plan Date Enter the actual or planned date of service in the format MM DD YYYY For example en
24. DEPARTMENT OF x ee HEALTH MOLINA AND HOSPITALS Medicaid Solutions Medicaid Louisiana Medicaid Management Information System LMMIS Electronic Medicaid Eligibility Verification System eMEVS Application User Manual Date Created 04 13 2004 Date Revised 11 12 2015 Prepared By Technical Communications Group eMEVS Application User Manual PROJECT INFORMATION Document Title Louisiana Medicaid Management Information System LMMIS eMEVS Application User Manual Technical Communications Group Molina Medicaid Solutions LMMIS QA Revision History Ne B D Copeland lt lt Description of Change LIFT 4 13 04 Various paragraph sentence changes additions throughout the document 4 13 04 Added Attch C Provider Enrollment Instructions 4 13 04 Added hrs of operations for Unisys Tech Support Dsk 4 13 04 D Copeland D Copeland Recaptured 90 of all eMEVS screens amp inserted them into appropriate sections of file to reflect new D Copeland Recipient Information text seen in 8 inquiry search screens 4 23 04 Added specific description for recipient first last name D Copeland as seen on Medicaid eligibility card to data field tables 4 24 04 Added new intro paragraph for all data field tables for D Copeland all 8 inquiries 4 24 04 Added new ending paragraph follow data field tables D Copeland for all 8 inquiries Changed definition of first three fields seen in all 8 inquiry
25. Hospital Hospital Inpatient Hospital Outpatient Emergency Services Professional Physician Visit Office Urgent Care MEDICAID Benefit Co Pay is 0 for In Plan Network and Out of Plan Network Chiropractic Hospital Hospital Inpatient Hospital Outpatient Emergency Services Professional Physician Visit Office Urgent Care Date Revised 11 12 2015 22 eMEVS Application User Manual Enroll Type B e Case 2 BYU BH onl Chisholm child who does not opt in Health Benefit Plan Coverage Benefit Service Type Code Active Coverage Health Benefit Plan Coverage Medicaid Deductible Health Benefit Plan Coverage Medicaid Benefit Description Health Benefit Plan Coverage Medicaid Managed Care Coordinator Specialized Behavioral Medicaid Health Care Managed Care Coordinator Dental Care Medicaid Active Coverage Medicaid Co Insurance Medicaid Co Payment Medicaid Please Note Individual coverage level applies to all benefits Case 3 BYU CSOC Child Enroll Type P Health Benefit Plan Coverage Benefit Service Type Code Active Coverage Health Benefit Plan Coverage Medicaid Deductible Health Benefit Plan Coverage Medicaid Benefit Description Health Benefit Plan Coverage Medicaid Managed Care Coordinator Medical Care Medicaid Managed Care Coordinator Specialized Behavioral Medicaid Health Care Managed Care Coordinator Dental Care Medicaid Active Coverage Medicaid Co Insurance Medicaid Co Payment Medic
26. PBM IS PERFORMRX Managed Care AMERIHEALTH CARITAS LOUISIANA Organization Telephone 888 756 0004 COORDINATED SYSTEM OF CARE CONTRACTOR Managed Care MAGELLAN Organization Telephone 800 424 4489 DENTAL BENEFITS PLAN MANAGER Payer MCNA INSURANCE COMPANY Telephone 855 701 6262 URL https portal MCNA net Eligible for Medicaid on Plan Date Medical Care Chiropractic Dental Care Hospital Hospital Inpatient Hospital Outpatient Emergency Services Pharmacy Professional Physician Visit Office Vision Optometry Behavioral Health Urgent Care MEDICAID Benefit Co Insurance is 096 for In Plan Network and Out of Plan Network Chiropractic Hospital Hospital Inpatient Hospital Outpatient Emergency Services Professional Physician Visit Office Urgent Care MEDICAID Benefit Co Pay is 0 for In Plan Network and Out of Plan Network Chiropractic Hospital Hospital Inpatient Hospital Outpatient Emergency Services Professional Physician Visit Office Urgent Care Date Revised 11 12 2015 23 eMEVS Application User Manual Case 4 BYU CSOC Child Enroll Type B e Chisholm child who does not opt in Health Benefit Plan Coverage Benefit Service Type Code Active Coverage Health Benefit Plan Coverage Medicaid Deductible Health Benefit Plan Coverage Medicaid Benefit Description Health Benefit Plan Coverage Medicaid Managed Care Coordinator Specialized Behavioral Medicaid Hea
27. Pepe LET tO PA Add cee Po 245 HOUSTON T Ty AXO Quer ee Papir Cover Lovet ronal Service Medow Care eur wee deum Petey Beanies MECICAME CUPPLUDWENT brew td ea fens fad 1 Service Lints tm Cover ega Levei hiia Savie Pte eet Wed COR iwa wae Wy sl uw 12 Vela Puspa Votes ea Marii 12 22 Porpora Pater erc Mantes 2046874 sun 54 XW 20 4 2 CT yy LAMedic tmd Lom Date Revised 11 12 2015 37 eMEVS Application User Manual 8 2 Case Manager An example of an eligibility Response from the 271 transaction for Case Management follows Medicaid Eligibility Verification System Web Application Navigation Menu Search Response Pr ntFriendhy Main Menu Help IMPORTANT DO use the HACK browser button please use the navigation menu Note For Technical Support Please Contact 877 598 8753 Note For Eligibility InFormation Support Please Contact 800 473 2783 or 225 924 5040 Make The date field formats have changed enter date in format CMS REGULATIONS LIMIT PROVIDING RECIPIENT ELIGIBILITY OLDER THAM THE MOST CURRENT 12 MOHTHS Search Criteria Search Type D and DOB Recipient ID Date of Birth Plan Date Provider Information rovider Information Atypical providers Harrie BIDDLE JROHNEMD
28. Wille LA 99999 For name ot address discrepancies recipients mud call LA Medicaid Eligibility Hoslirse 1 877 252 2447 wa E Geers ES mo Mima Gare coordinator Eed for Gee Fil owes Descrip ion edi Gare or Breas E bp seni Bo oral icri Sie o Health Benefit Plan Coverage Service Type Code Irmurance Type Pian Coverage Description Active Coverage Health Plan Coverage Medeor ma Ella ter sa Pian Date 77 Pian Begin Date 056201 2007 De duztible Heath Plan C pana Pls Bude Deductbis rg 50 fer in Pan Fieber aed Out of Plan Hetaork Benefit Descriptio Heath Banat Pun Coanage Lied pad PREFERRED LANGUAGE ENGLISH Managed Care A Meda ed BAYOU HEALTH PLAN Benefit Ela gin 09 01 2012 PHARMACY PER IS PERF ORL Klanaged Care Organization Telephone 922 0007 or Additional Payor Care W Plan lietercak 353708 Payer BLUE CROSS OF TEXAS PO BOX 66043 9 DALLAS Tx 75266 0000 Onhwr of AddiGonal Payor Cie Poly i oe Te Ebgbie for Leda on Plan Care Cheropractiic Deal Care Hospital Hospital tapa Emergency Senec Pharmacy To vea iicp Vrpon Optometry Meta Heath Urs MEDICAID Benest Co inguranee ra O8 for In Plan He and Cut e Pips bite Hago Hoge mm E Outpatient Emergency Sener Freier ice Ligen Care MEDCAL A epee ators p
29. aid Please Note Individual coverage level applies to all benefits Insurance Type Plan Coverage Description Eligible for Medicaid on Plan Date Plan Begin Date 02 01 2015 Health Plan Base Deductible is 0 for In Plan Network and Out of Plan Network PREFERRED LANGUAGE ENGLISH BAYOU HEALTH PLAN Managed Care AMERIHEALTH CARITAS LOUISIANA Organization Telephone 888 756 0004 DENTAL BENEFITS PLAN MANAGER Payer MCNA INSURANCE COMPANY Telephone 855 701 6262 URL https portal MCNA net Eligible for Medicaid on Plan Date Medical Care Chiropractic Dental Care Hospital Hospital Inpatient Hospital Outpatient Emergency Services Pharmacy Professional Physician Visit Office Vision Optometry Behavioral Heatlh Urgent Care MEDICAID Benefit Co Insurance ts 096 for In Plan Network and Out of Plan Network Chiropractic Hospital Hospital Inpatient Hospital Outpatient Emergency Services Professional Physician Visit Office Urgent Care MEDICAID Benefit Co Pay is 0 for In Plan Network and Out of Plan Network Chiropractic Hospital Hospital Inpatient Hospital Outpatient Emergency Services Professional Physician Visit Office Urgent Care Insurance Type Plan Coverage Description Eligible for Medicaid on Plan Date Plan Begin Date 02 01 2015 Health Plan Base Deductible is 0 for In Plan Network and Out of Plan Network PREFERRED LANGUAGE ENGLISH BAYOU HEALTH PLAN PHARMACY
30. ar Screen Provider Name DHH EXEC MGMT Provider ID IMPORTANT The following field is only available to Internal Providers Target Server gt Entity Type Person gt Social Security Number 9 Digit Number Recipient Last Hame vc First Hame fs Suffix Plan Date 12 25 2011 E mmy dd yyyy Hote Requirecd fields are in red Submit Enter the values for each of the search fields except for those 1 Provider Name and which are already filled out All fields but the Suffix are required as indicated by the note at the bottom of the screen Recipient Name and SSN Inquiry Fields Field Name Field Description Provider Name The first 13 characters of the provider s last name is filled in by the application The 10 digit National Provider Identifier of the provider whose login process has been authenticated is filled in by the application Note An atypical provider sees the appropriately labeled 7 digit Louisiana Medicaid ID not the NPI Last Name Enter the Recipient s Last Name up to 25 letters as seen on the Medicaid eligibility card Enter the Recipient s Suffix name up to 3 letters as seen on the Medicaid eligibility card not required Social Security Number Enter the 9 digit social security number in the format NNNNNNNNN Do not enter hyphens enter only numbers Plan Date Enter the actual or planned date of service in the format MM DD YYYY For example enter 04 09 2008 for a servic
31. ation User Manual Case 6 ICF DD Adults Excluded no chanqes Health Benefit Plan Coverage Benefit Service Type Code Insurance Type Plan Coverage Description Active Coverage Health Benefit Plan Coverage Medicaid Eligible for Medicaid on Plan Date Plan Begin Date 07 01 2011 Deductible Health Benefit Plan Coverage Medicaid Health Plan Base Deductible is 0 for In Plan Network and Out of Plan Network Benefit Description Long Term Care Medicaid Benefit Description Health Benefit Plan Coverage Special Low Income Medicare Beneficiary Benefit Begin 11 01 2007 Other or Additional Payor Health Benefit Plan Coverage Medicare Part A Benefit Begin 11 01 2007 Other or Additional Payor Health Benefit Plan Coverage Medicare Part B Benefit Begin 11 01 2007 Other or Additional Payor Health Benefit Plan Coverage Other Eligible for Medicare Part D Benefit Begin 01 01 2009 Benefit Description Health Benefit Plan Coverage Medicaid Active Coverage Medicaid Co Insurance Medicaid Co Payment Medicaid PREFERRED LANGUAGE ENGLISH Eligible for Medicaid on Plan Date Medical Care Chiropractic Dental Care Hospital Hospital Inpatient Hospital Outpatient Emergency Services Pharmacy Professional Physician Visit Office Vision Optometry Mental Health Urgent Care MEDICAID Benefit Co Insurance is 096 for In Plan Network and Out of Plan Network Chiropractic Hospital Hospital Inpatient Hospital Outpatient Emergency Services Professional
32. ber _ _ Digit Number Plan Date BE mm dd yyyy Note Required fields are red Submit Enter the values for each of the search fields except for those i e Provider Name and which are already filled out All fields are required as indicated by the note at the bottom of the Screen CCN and SSN Inquiry Fields Provider Name The first 18 characters of the provider s last name is filled in by the application The 10 digit National Provider Identifier of the provider whose login process has been authenticated is filled in by the application Note An atypical provider sees the appropriately labeled 7 digit Louisiana Medicaid ID not the NPI Card Control Number Enter the 16 digit Card Control Number of the recipient for whom you want eligibility verification Social Security Number Enter the recipient s 9 digit social security number in the format NNNNNNNNN Do not enter hyphens enter only numbers Plan Date Enter the actual or planned date of service in the format MM DD YYYY For example enter 04 09 2008 for a service date of April 9 2008 Alternatively use the calendar function to enter the date When all the fields have been entered select the Submit button If any required fields have not been completed or are entered with invalid data an error message will be displayed see 3 2 2 Make the appropriate corrections and re submit the search A sample response is provided in 4 0 Date Revi
33. cal provider sees the appropriately labeled 7 digit Louisiana Medicaid ID not the NPI Social Security Number Enter the 9 digit social security number in the format peel NNNNNNNNN Do not enter hyphens enter only numbers Date of Birth Enter the recipient s Birth Date in the format MM DD YYYY For example enter 04 17 1962 for a birth date of April 17 1962 Alternatively use the calendar function to enter the date see 3 2 1 Plan Date Enter the actual or planned date of service in the format MM DD YYYY For example enter 04 09 2008 for a service date of April 9 2008 Alternatively use the calendar function to enter the date When all the fields have been entered select the Submit button If any required fields have not been completed or are entered with invalid data an error message will be displayed see 3 2 2 Make the appropriate corrections and re submit the search A sample response is provided in 4 0 Date Revised 11 12 2015 11 eMEVS Application User Manual 3 6 Inquiry by Recipient ID and DOB Medicaid Eligibility Verification System Web Application Navigation Menu Search Response PrintFriendly Main Menu Help IMPORTANT DO HOT use the BACK browser button please use the navigation menu Note For Technical Support Please Contact 877 598 8753 Note For Eligibility Infor mation Support Ped ntac 473 924 5040 Note date field formats have changed rd D
34. ct 800 473 2783 or 225 924 5040 Note The date field formats have changed enter date in MM DD YYYY format HOTE CMS REGULATIONS LIMIT PROVIDING RECIPIENT ELIGIBILITY OLDER THAN THE MOST CURRENT 12 MONTHS Search By Card Control Number and DOB Clear Screen Provider Name DHH EXEC Provider ID 1413135 IMPORTANT The following field is only available to Internal Providers Target Server Saavik Entity Type Person Card Control Number 16 Digit Number Date Of Birth ES mm dd yy Plan Date mm dd yyyy Note Required fields are in red Submit Enter the values for each of the search fields except for those i e Provider Name and which are already filled out All fields are required as indicated by the note at the bottom of the Screen CCN and Inquiry Fields The first 13 characters of the provider s last name is filled in by the application The 10 digit National Provider Identifier of the provider whose login process has been authenticated is filled in by the application Note An atypical provider sees the appropriately labeled 7 digit Louisiana Medicaid ID not the NPI Card Control Number Enter the 16 digit Card Control Number of the recipient for whom you want eligibility verification Date of Birth Enter the recipient s Birth Date in the format MM DD YYYY For example enter 04 17 1962 for a birth date of April 17 1962 Alternatively use the calendar function to enter the
35. ds except for those 1 Provider Name and which are already filled out All fields are required as indicated by the note at the bottom of the Screen Recipient ID and SSN Inquiry Fields Field Name Field Description Provider Name The first 18 characters of the provider s last name is filled in by the application The 10 digit National Provider Identifier of the provider whose login process has been authenticated is filled in by the application Note An atypical provider sees the appropriately labeled 7 digit Louisiana Medicaid ID not the NPI Recipient ID Enter the 13 digit Recipient ID of the recipient for whom you want eligibility verification Social Security Number Enter the 9 digit social security number in the format NNNNNNNNN Do not enter hyphens enter only numbers Plan Date Enter the actual or planned date of service in the format MM DD YYYY For example enter 04 09 2008 for a service date of April 9 2008 Alternatively use the calendar function to enter the date When all the fields have been entered select the Submit button If any required fields have not been completed or are entered with invalid data an error message will be displayed see 3 2 2 Make the appropriate corrections and re submit the search A sample response is provided in 4 0 Date Revised 11 12 2015 13 eMEVS Application User Manual 3 8 Inquiry by Recipient ID and Name Medicaid Eligibility Verification System Web
36. e date of April 9 2008 Alternatively use the calendar function to enter the date Enter the Recipient First Name up to 20 letters as seen on the Medicaid eligibility card Date Revised 11 12 2015 15 eMEVS Application User Manual When all the fields have been entered select the Submit button If any required fields have not been completed or are entered with invalid data an error message will be displayed see 3 2 2 Make the appropriate corrections and re submit the search A sample response is provided in 3 10 Inquiry by Recipient Name and DOB Medicaid Eligibility Verification System Web Application Navigation Menu Search Response PrintFriendly Main Menu Help IMPORTANT DO HOT use the BACK browser button please use the navigation menu Note For Technical Support Please Contact 877 598 8753 Note For Eligibility Information Support Please Contact 800 473 2783 or 225 924 5040 Note The date field formats have changed enter date in MM DD YYYY format NOTE CMS REGULATIONS LIMIT PROVIDING RECIPIENT ELIGIBILITY OLDER THAN THE MOST CURRENT 12 MONTHS Search By Recipient Name and DOB Clear Screen Provider Name DHH EXEC MGMT Provider ID IMPORTANT The following field is only available to Internal Providers Target Server Saavik Entity Person Recipient Last Name First Name Suffix Date Of Birth mm dd yyyy Plan Date EH mm dd yyyy Note Required fields are in red
37. ecommendation perform every three years age 21 65 Last test No paid Medicaid claims found Recommended next test As soon as clinically possible 2 Breast Cancer Screening Mammography Recommendation perform every 1 2 years age 40 and older Last test 09 17 2003 Recommended next test 0971772004 www ahcpr qav cliniczuspstfhix htm U S Preventive Services Task Force USPSTF recommendations 2003 Print Screen button here Exit this screen view additional clinical data for this patient click here ta qo to e CDI electronic Clinical Data Inquiry Service 03 20 2006 Date Revised 11 12 2015 33 eMEVS Application User Manual 7 3 2 Male with Cancer 2 Practice Guidelines Umum considered and recommended for the Periodic Health Examination general population Our LaMedicaid clinical database reveals when the last test interventi i performed and when the next test intervention is due for 1 Prostate Specific Antigen Test PSA Test Recommendation perform annually Years 50 and older Last test No paid Medicaid claims found Recommended next test As soon as clinically possible 2 Total Blood Cholesterol Measurement Test Recommendation perform annually Years 45 65 Last test No paid Medicaid claims found Recommended next test As soon as clinically possible 3 Fecal Occult Blood Test FOBT and or Sigmoidoscopy Recommendation perform annually Years 25 and older
38. ician Visit Office Urgent Care MEDICAID Benefit Co Pay is 0 for In Plan Network and Out of Plan Network Chiropractic Hospital Hospital Inpatient Hospital Outpatient Services Professional Physician Visit Office Urgent Care Insurance Type Plan Coverage Description Eligible for Medicaid on Plan Date Plan Begin Date 09 01 2011 Health Plan Base Deductible is 0 for In Plan Network and Out of Plan Network PREFERRED LANGUAGE ENGLISH BAYOU HEALTH PLAN Managed Care AMERIHEALTH CARITAS LOUISIANA Organization Telephone 888 756 0004 DENTAL BENEFITS PLAN MANAGER Benefit Begin 07 01 2014 Payer MCNA INSURANCE COMPANY Telephone 855 701 6262 URL https portal MCNA net Eligible for Medicaid on Plan Date Medical Care Chiropractic Dental Care Hospital Hospital Inpatient Hospital Outpatient Emergency Services Pharmacy Professional Physician Visit Office Vision Optometry Behavioral Health Urgent Care MEDICAID Benefit Co Insurance is 096 for In Plan Network and Out of Plan Network Chiropractic Hospital Hospital Inpatient Hospital Outpatient Emergency Services Professional Physician Visit Office Urgent Care MEDICAID Benefit Co Pay is 0 for In Plan Network and Out of Plan Network Chiropractic Hospital Hospital Inpatient Hospital Outpatient Emergency Services Professional Physician Visit Office Urgent Care Date Revised 11 12 2015 24 eMEVS Applic
39. ity or claim status request and the patient being queried has records in the new disease management database Eclinical Disease Management The database is made up of the following 9 tables Base Eligible Clinical Tab Dimension Blood Tests Tab Dimension Breast Cancer Tab Dimension Cervical Cancer Tab Dimension Colorectal Cancer Tab Dimension Diabetes Tab Dimension Prostate Cancer Tab EliglD CurrlD Provider Display Control Tab So ROLL Russ 7 2 How It Works When the Provider makes an eligibility and or claims status request using the eMEVS or eCDI application the Recipient ID is obtained and used to query the Disease Management database Depending on the gender of the recipient a subset of the tables in the database is queried If hits are found in any of these tables the pop up will be displayed on the end user s workstation The type of pop up displayed is dependent on the type of disease information found An example of the diabetes pop up that is displayed when the recipient has diabetes 1 as follows Date Revised 11 12 2015 31 eMEVS Application User Manual Our LaMedicaid clinical database indicates that your patient P g EN a diagnosis of DIABETES Recommended preventive screenings tests for DIABETES Types I amp II 1 Hemoglobin 1 perform twice annually Last test Mo paid Medicaid claim found Recommended next test As soon as clinically possible 2 Blood LDL Cholesterol perform annually Last tes
40. l Number and SSN SSN and DOB Recipient ID and Recipient ID and SSN Recipient ID and Name Recipient Name and SSN Recipient Name and DOB You must also enter a service date to obtain the eligibility information for the specified recipient 3 1 Navigation Menu for eMEVS The five eMEVS navigation links Search Response Print Friendly Main Menu and Help assist providers with navigating within the eMEVS Web Application If the user s mouse hovers 1 remains stationary for a short period of time over one of these links a special message will appear to further identify the purpose of the link Date Revised 11 12 2015 4 eMEVS Application User Manual 3 1 1 eMEVS Navigation Menu Links The Main Menu and Help navigation links are always enabled the other three links Search Response and Print Friendly are enabled as needed when you operate the application Medicaid E gibility VerfNcation System Web Application Navigatiog Menu Search Response PrintFriendly Menu Help IMPORTANT DO HOT use the BACK browser button please use the navigation menu Note Technical Support Please Contact 877 598 8753 Note For Eligibility Information Support Please Contact 800 473 2783 or 225 924 5040 Note The date field formats have changed enter date in MM DD YYY Y format NOTE CMS REGULATIONS LIMIT PROVIDING RECIPIENT ELIGIBILITY OLDER THAN THE MOST CURRENT 12 MONTHS Search By Card Control Number a
41. l Practice Guidelines Reminder for Interventions considered and recommended for the Periodic Health Examination general population Gur LaMedicaid clinical database reveals when the last test interventian s listed when the next test intervention is due for 1 Cervical Cancer Screening Pap Smear Recommendation perform every three years 21 65 Last test No paid Medicaid claims found Recommended next test As soon as clinically possible 2 Breast Cancer Screening Mammography Recommendation perform every 1 2 years age 40 and alder Last test 09 17 2003 Recommended next test 0971772004 WWI ahcpr qav clinic uspstfix htm U S Preventive Services Task Force USPSTF recommendations 2003 Print Screen button here Exit this screen To view additional clinical data for this patient click here to go to e CDI felectronic Clinical Data Inquiry Service 03 20 2006 Date Revised 11 12 2015 36 eMEVS Application User Manual 8 0 APPENDIX D SPECIAL ELIGIBILITY RESPONSES The following pages are examples of new responses for programs added to eMEVS since its inception 8 1 Medicare Part D An example of an eligibility response for a recipient eligible for Medicare Part D is shown below The Medicare Part D eligibility is shown in a box Medicaid Eigibiley VerificsSon System Web Navigation Mera Seah ex uetfoesfr ManMenu fet OPE 0 wes the FACE
42. lth Care Managed Care Coordinator Dental Care Medicaid Active Coverage Medicaid Co Insurance Medicaid Co Payment Medicaid Please Note Individual coverage level applies to all benefits Case 5 LTC Enroll Typez B Health Benefit Plan Coverage Benefit Service Type Code Active Coverage Health Benefit Plan Coverage Medicaid Deductible Health Benefit Plan Coverage Medicaid Benefit Description Long Term Care Medicaid Benefit Description Health Benefit Plan Coverage Medicaid Managed Care Coorainator Specialized Behavioral Medicaid Health Care Managed Care Coordinator Dental Care Medicaid Active Coverage Medicaid Co Insurance Medicaid Co Payment Medicaid Insurance Type Plan Coverage Description Eligible for Medicaid on Plan Date Plan Begin Date 02 01 2015 Health Plan Base Deductible is 0 for In Plan Network and Out of Plan Network PREFERRED LANGUAGE ENGLISH COORDINATED SYSTEM OF CARE CONTRACTOR Managed Care MAGELLAN Organization Telephone 800 424 4489 DENTAL BENEFITS PLAN MANAGER Payer MCNA INSURANCE COMPANY Telephone 855 701 6262 URL https portal MCNA net Eligible for Medicaid on Plan Date Medical Care Chiropractic Outpatient Emergency Pr ici Office Vision Optometry Behavioral Health Urgent Care MEDICAID Benefit Co Insurance is 0 for In Plan Network and Out of Plan Network Chiropractic Hospital Hospital Inpatient Hospital Outpatient Emergency Services Professional Phys
43. nd DOB Clear Screen Provider Name DHH EXEC MGMT Provider ID 1413135 IMPORTANT The following field is only available to Internal Providers Target Server Saavik Entity Type Person Card Control Number 16 Digit Number Date Of Birth Plan Date vc _ mm dd yyyy Hote Required fields are in red Submit 3 1 2 Search The Search link is enabled when you are viewing an eMEVS response see 4 0 It returns you to the main search page shown above where you may make another inquiry 3 1 3 Response The Response link is enabled when you have finished viewing a response and have returned to the Search page shown in 3 1 1 It returns you to the last response from eMEVS in case you want to view it again Date Revised 11 12 2015 5 eMEVS Application User Manual 3 1 4 Print Friendly The Print Friendly link is enabled whenever the application displays data for which you might need hardcopy When you select the link a new window opens with the data to print and two control links Print and Close h t ps m TT et lrk al 08 00 dim wides manet E gps 17192 0017 peor echni ae Laer riens ire d B Im Page ge DHH Exec Mar Health Care Financing Administration ccn Wational Provider Identifier Subscriber Information Subscriber ember Hlarmilicamen Nurriber Date of Birth If you select the Close button the ne
44. omes active Selecting the Forward button takes the user to the page that was displayed when the user selected the Back button If the Back button was selected several times continuing to select the Forward button takes the user to the last page displayed during the current Web browser session Refresh Selecting the Refresh button causes the program to read the qata from the database and redisplay the current page with any database changes that were made since the page was last displayed This would usually be required only after changing screens via the Back and or Forward buttons Date Revised 11 12 2015 27 eMEVS Application User Manual Full Screen Selecting the Full Screen button expands the current page to fill the entire workstation display screen Selecting this button again returns the page to its original size Print Selecting the Print button causes the currently displayed page to print on the printer set up at the user s workstation as the default printer Minimize d Selecting the Minimize button causes the currently displayed page to close and an appropriate icon to be displayed on the Windows task bar Close x Selecting the Close button causes the currently displayed page to close Date Revised 11 12 2015 28 eMEVS Application User Manual 6 0 APPENDIX B EMEVS SWIPE CARD CROSSWALK PROPRIETARY SWIPE CARD MESSAGES HIPAA STANDARDIZED MESSAGES Important Note The table below is provided s
45. plications Area on the www lamedicaid com website is accessed the eMEVS Web Application is deployed by selecting one of eight inquiry options entering the required data then viewing the response Section 3 0 depicts an example of each specific query option while describing the mandatory information required to perform each query Only fifteen transactions or inquiry requests are allowed per session Providers who have more than fifteen requests must log into a new session in order to complete their inquiries When all mandatory fields of the inquiry page have been entered and the Submit button is selected a transaction is sent to the MEVS system The response is displayed on the web browser Section 4 0 shows an example of a response with explanations Date Revised 11 12 2015 1 eMEVS Application User Manual 2 0 ACCESSING THE APPLICATION 1 Open your web browser and enter the URL for the Louisiana Medicaid main menu http www lamedicaid com Login in to the Provider Applications area in accordance with the instructions located on the Provider Web Account Registration Instructions link at http www lamedicaid com provweb1 Provweb Enroll website enrollment htm If you do not already have a web account this guide will explain how you get a web account to access provider applications If you do already have an account the guide explains how to login to the provider application area The following screen is displayed Select
46. r Last test 11 17 2003 Recommended next test 11 17 2004 Guide to Clinical Preventive Services 2nd Edition 1996 Report to the U S Preventive Services Task Force American Cancer Society Guidelines for the cancer related checkup update 1993 American Urological Association and Print Screen button here view additional clinical data for t electronic Clinical Data Inquiry 225 237 3370 Date Revised 11 12 2015 34 eMEVS Application User Manual 7 5 Print Capabilities The user will have the ability to print the information being displayed in the pop up window by clicking the Print Screen button here pertorm annually S and older Last test paid Medicaid claims found Recommended next test As soon as clinically possible z Total Blood Cholesterol Measurement Test Recommendation perform annually fears 45 65 Last test No paid Medicaid claims found Recommended next test As soon as clinically possible 3 Fecal Occult Blood Test FOBT and or Sigmoidoscopy Recommendation perform annually Years 25 and alder Last test 11 17 2003 Recommended next test 11 17 2004 Guide ta Clinical Preventive Services znd Edition 1996 Report to the U S Preventive Services Task Force American Cancer Society Guidelines for the cancer related checkup update 1993 American Urological Associati ollege of Radiology Exit this screen
47. rmat mm dd yyyy for instance for May 1 2008 type 05 01 2008 in the date text box as shown below Medicaid Eligibility Verification System Web Application Navigation Menu Search Response PrintFriendly Main Menu Help IMPORTANT DO NOT use the BACK browser button please use the navigation mgf u Note For Technical Support Please Contact 877 598 8753 Note For Eligibility Information Support Please Contact 800 473 2789f or 225 924 5040 Note The date field formats have changed enter date in MM DD YY YTormat NOTE CMS REGULATIONS LIMIT PROVIDING RECIPIENT ELIGIBILITY OLDER SAAN THE MOST CURRENT 12 MONTHS Search By SSN and DOB Clear Screen Provider Name DHH EXEC MGMT Provider ID IMPORTANT The foffwing field is only available to Internal Providers Target Server Saavik v Entity Type Person Social Security Number Z 3 9 Digit Number Date Of Birt mm dd yyvy Plan Date mm dd yyyy Note Required fields are in red Submit Date Revised 11 12 2015 eMEVS Application User Manual Alternatively you may click on the calendar icon to enable the calendar feature which allows you to click on the date you want to specify Use the control arrows to choose month and or a year then click on the day Mon Tue d m Fri Sat 2 e i B e a S le sm E eSB ee meg 5 m tn a m 3 2 2 Error Messages The
48. rt of the eMEVS response If there is no Managed Care Coordinator listed for the Plan Coverage Description Medical Care or Specialized Behavioral Health Care claims should be sent to Molina Medicaid Solutions Medicaid Eligibility Verification System Web Application Navigation Menu Search Response PrintFriendly Main Menu Help IMPORTANT DO NOT use the BACK browser button please use the navigation menu Note For Technical Support Please Contact 877 598 8753 Note For Eligibility Information Support Please Contact 800 473 2783 or 225 924 5040 Note The date field formats have changed enter date in MM DD YYYY format NOTE CMS REGULATIONS LIMIT PROVIDING RECIPIENT ELIGIBILITY OLDER THAN THE MOST CURRENT 12 MONTHS Search Type RecipientID and Recipient D T Date of Birth oo EE Plan Date 08 27 2015 Subscriber Information Provider Information Name Provider DHH EXEC MGMT MOLINA PBMSTAF SubscriberiD 020 7777777773 Date of Birth 0125 8 Sex Female Address 2000 ROS B For name or address discrepancies recipients must call LA Medicaid Eligibility Hotline 1 877 252 2447 Submitter ID 2252166370 Ifthere is no Managed Care Coordinator listed for the Plan Coverage Description Medical Care or Specialized Behavioral Health Care claims should be sent to Molina Medicaid Solutions Date Revised 11 12 2015 21 eMEVS Application User Manual 4 2 2 Health Benefit Plan Coverage Below are
49. search scrns provider information no 4 24 04 D Copeland longer selectable self populating fields based on login Ids provider data from PMF 4 26 04 Updated footer to state eMEVS User Manual as D Copeland current name of web app 4 28 04 Updated Sect 3 10 Valid amp Invalid eMEVS D Copeland Hesponses tables 4 28 04 Updated Sect 3 10 inserted new scrns for Valid amp D Copeland Invalid eMEVS Responses e MEVS throughout document to eMEVS screen captures 11 29 04 Hemoved reference to Card Issue Date in Sections 3 1 3 2 amp 3 3 Replaced all screens in Section 3 0 to reflect the removal of the Card Issue Date Added reference in Section 2 0 to reflect that REVS has the same search criteria as MEVS Reformatted document in accordance with standards established by QA Section 3 10 incorporated into oection 3 1 Modified date format instructions as needed deleted references to Provider Type in tables updated screen shots as needed added Appendix D D Copeland D Copeland B Vazquez H Eyster Kearney S Triggs R O1 O Sheehan and Appendix E updated table in 3 1 6 Date Revised 11 12 2015 li eMEVS Application User Manual 5 18 06 Added block arrows as needed to screenshots pp 3 R Sheehan 4 bolded button names p 6 changed all instances of MEVS to eMEVS replaced screenshot p 10 added grid lines to table p 11 changed 3 1 2 to 3
50. sed 11 12 2015 10 eMEVS Application User Manual 3 5 Search by SSN and DOB Medicaid Eligibility Verification System Web Application Navigation Menu Search Response PrintFriendly Main Menu Help IMPORTANT DO HOT use the BACK browser button please use the navigation menu Note For Technical Support Please Contact 877 598 8753 Note For Eligibility Information Support Please Contact 800 473 2783 or 225 924 5040 Note The date field formats have changed enter date in MM DD YYYY forma HOTE CMS REGULATIONS LIMIT PROVIDING RECIPIENT ELIGIBILITY OLDER THAN THE MOST CURRENT 12 MONTHS Search By SSN and DOB Clear Screen Provider Name DHH EXI sh Provider ID IMPORTANT The following field is only available to Internal Providers Target Server Saavik Entity Person Social Security Humber 9 Digit Number Date Of Birth mm dd yyyy Plan Date EH mm dd yyyy Note Required fields are in red Submit Enter the values for each of the search fields except for those i e Provider Name and which are already filled out All fields are required as indicated by the note at the bottom of the Screen SSN and Inquiry Fields Provider Name The first 18 characters of the provider s last name is filled in by the application The 10 digit National Provider Identifier of the provider whose login process has been authenticated is filled in by the application Note An atypi
51. ss Invalid missing Patient ID Please than 13 digits Correct and Resubmit Last or First Recipient name missing Invalid missing Patient Name Name Please Correct and Resubmit SSN Social security number Required application data missing missing invalid Please Correct and Resubmit Date of Birth Date of birth missing or invalid Invalid missing Date of Birth Please Correct and Resubmit Date of Birth Date of birth must not be prior to Invalid missing Date of Birth year 1875 Please Correct and Resubmit Date Revised 11 12 2015 29 eMEVS Application User Manual eMEVS INQUIRY RESPONSE CROSSWALK Proprietary Swipe Card to HIPAA Standardized Messages Field Name Louisiana Medicaid Proprietary HIPAA Required Standardized Swipe Card Responses Swipe Card Responses Service Date Service date missing invalid Invalid missing Date of Service Please Correct and Resubmit Service Date Service more than 12 months old Date of service Not Within Allowable Inquiry Period Please Correct and Resubmit Service Date Service date may not exceed last Date of service in Future Please day of current month Correct and Resubmit Recipient Recipient not on file this will be Patient Not Found Please Correct Query returned for any query combination and Resubmit that results in the recipient not found on Recipient table Date of Death Recipient ineligible deceased when Date of Death Precedes Da
52. t No paid Medicaid claim found Recommended next test As soon as clinically possible hh Hc 3 Eye Exam retinal perform annually by eye specialist Last exam 09 13 2005 Recommended next test 09 13 2006 4 Microalbuminuria test perform annually unless on ACE I ARB Last test paid Medicaid claim found Recommended next test As soon as clinically possible American Diabetes Association ADA Standards of Medical Care in Diabetes 2005 ADA Website Print Screen button here Exit this screen To view additional clinical data for this patient click here to qo to e CDI electronic Clinical Data Inquiry 1413135 For women the following tables are queried e Cancer Check o Dimension Cervical Cancer Tab o Dimension Breast Cancer Tab e Diabetes Check o Dimension Diabetes Tab For men the following tables are queried e Cancer o Dimension Colorectal Cancer Tab o Dimension Prostate Cancer Tab o Dimension Blood Tests Tab e Diabetes Check o Dimension Diabetes Tab 7 3 Samples 7 3 1 Female with Cancer Date Revised 11 12 2015 32 eMEVS Application User Manual icaid amp 3 Clinical Practice Guidelines Reminder for Interventions considered and recommended for the Periodic Health Examination general population Our LaMedicaid clinical database reveals when the last test interventian s listed pees when the next test interventian is due for 1 Cervical Cancer Screening Pap Smear R
53. te of DOD date of service Service Please Correct and Resubmit Eligibility Query Recipient not eligible on date of Inactive service Eligibility Query Dual Eligibility message in Cannot Process Overlapping clarification message Eligibility on DOS Lock In Unable to Respond contact Unable to Respond at Current Time Provider Molina provider services in Resubmission Not Allowed clarification message if Lock In Provider not on file PCP Provider Unable to Respond contact Unable to Respond at Current Time CC Molina provider services in Resubmission Not Allowed clarification message if PCP Provider not on file Insurance Nbr Unable to Respond contact Required application data missing Company Molina provider services in Hesubmission Not Allowed Name clarification message if Insurance Company Number not on file Address or Policy Holder Name Date Revised 11 12 2015 30 eMEVS Application User Manual 7 0 APPENDIX C DISEASE MANAGEMENT 7 1 Introduction A new feature pop up windows containing potential patient disease information has been added to eMEVS and electronic Clinical Data Inquiry eCDI For more information regarding eCDI refer to the main menu under the provider applications area at www lamedicaid com The Disease Management pop ups are displayed from both the eMEVS and eCDI applications whenever the Provider performs an eligibil
54. ter 04 09 2008 for a service date of April 9 2008 Alternatively use the calendar function to enter the date When all the fields have been entered select the Submit button If any required fields have not been completed or are entered with invalid data an error message will be displayed see 3 2 2 Make the appropriate corrections and re submit the search A sample response is provided in 4 0 Date Revised 11 12 2015 12 eMEVS Application User Manual 3 7 Inquiry by Recipient ID and SSN Medicaid Eligibility Verification System Web Application Navigation Menu Search Response PrintFriendly Main Menu Help IMPORTANT DO HOT use the BACK browser button please use the navigation menu Note For Technical support Please Contact 877 598 8753 Note For Eligibility Information Support Please Contact 800 473 2783 225 924 5040 Note The date field formats have changed enter date in MM DD YYYY format NOTE CMS REGULATIONS LIMIT PROVIDING RECIPIENT ELIGIBILITY OLDER THAN THE MOST CURRENT 12 MONTHS Search By Recipient ID and SSN Clear Screen Provider Name DHH EXEC MGMT Provider ID IMPORTANT The following field is only available to Internal Providers Target Server Saavik Entity Type Person gt Recipient ID 13 Digit Number Social Security Number Digit Number Plan Date 12 28 2011 Eu mmy dd yyvyy Hote Required fields are in red Submit Enter the values for each of the search fiel
55. the Medicaid Eligibility Verification System link Louisi AU 2 Change Password Change Account Info Logout Help For Technical Support call Provider Applications Area toll free 1 877 598 8753 The application s listed below are for authorized use fly Click on an application link to access the application Warning Unauthorized use Provider Applications of this site or the information contained herein is LAMEDICAID COM Fact Sheet prohibited by the Louisiana Department of Health and Hospitals Restricted Provider Applications Administrative Tools Electronic Clinical Data Inquiry Claim Status Inquiry Electronic Prior Authorization Provider Ownership Enrollment Medicaid Eligibility Verification System National Provider Identifier Document Provider Applications Area Date Modified 1 24 03 Date Revised 11 12 2015 eMEVS Application User Manual 4 The Medicaid Eligibility Verification System Web Application screen is displayed For Technical Support call toll free Medicaid Eligibility Verification System Web Application 1 877 598 8753 Navigation Menu Provider Logout Search Response PrintFriendly Main Menu Help IMPORTANT DO NOT use the BACK browser button please use the navigation menu Warning Unauthorized use Note For Technical Support Please Contact 877 598 8753 ere Note For Eligibility Information Support Please Contact 800 473 2783 or 225 92
56. the information will be present on the MEVS response with 0 in the fields This does not imply that the recipient has other primary insurance coverage If other coverage is present on the recipient s Medicaid file the name and contact information will be displayed see above NOTE Pharmacy Drug co pays are displayed for pharmacists through POS when applicable for the drug Health Benefit Plan Coverage Service Insurance Benefit Type Tvpe Plan Coverage Description Code Active Health Medicaid Eligible for Medicaid on Plan Date Coverage Benefit Plan Plan Begin Date 03 01 2013 Coverage Deductible Health Medicaid Health Plan Base Deductible is 0 for In Plan Network and Out of Plan Benefit Plan Network Coverage Benefit Health Medicaid PREFERRED LANGUAGE ENGLISH Description Benefit Plan Coverage Managed Medical Medicaid BAYOU HEALTH PLAN Care Care Benefit Begin 04 01 2013 Coordinator Managed Care COMMUNITY HEALTH SOLUTIONS OF Organization Telephone 855 247 5248 Active Medicaid Eligible for Medicaid on Plan Date Medical Care Chiropractic Hospital Coverage Hospital Inpatient Hospital Outpatient Emergency Services Pharmacy Professional Physician Visit Office Vision Optometry Mental Health Urgent Care Co Insurance Medicaid MEDICAID Benefit Co Insurance is 0 for In Plan Network and Out of Plan Network Chiropractic Hospital Hospital Inpatient Hospital Outpatient Emergency Services Professional Ph
57. trictly to assist providers who have used the swipe card version of the Medicaid Eligibility Verification System eMEVS This is intended to assist them in their transition from seeing Louisiana proprietary responses to seeing HIPAA standardized responses eMEVS INQUIRY RESPONSE CROSSWALK Proprietary Swipe Card to HIPAA Standardized Messages Field Name Louisiana Medicaid Proprietary HIPAA Required Standardized Swipe Card Responses Swipe Card Responses Planned Planned Unavailable in Unable to Respond at Current Time Unavailable clarification Resubmission Allowed Provider ID Provider number missing or not Invalid Missing Provider ID Please numeric Correct and Resubmit Provider ID Provider ID must begin with 1 Invalid Missing Provider ID Please Correct and Resubmit Provider ID Provider Attending provider noton Provider Not on File Please Correct file and Resubmit Provider ID Provider not eligible on dates of Provider Ineligible for Inquiries service Please Correct and Resubmit Card Control Card control number missing invalid Invalid Missing subscriber insured ID Please Correct and Resubmit Card Issue Card issue date missing invalid Inappropriate Date Please Correct Date and Resubmit Card Issue Card may not be used prior to Inappropriate Date Please Correct Date effective date and Resubmit Recipient ID Recipient number invalid or le
58. w window opened when you selected Print Friendly is closed Click the Print link to continue to the print dialogue box which will look similar to the one shown below Microsoft XPS Network UDS PDFCreator ProvRelHP4 Document 132 on Click the Print button for your hardcopy Date Revised 11 12 2015 eMEVS Application User Manual 3 1 5 Main Menu Selecting the Main Menu link at any point in the application returns you to the Provider Applications Area page where you may select another application or re enter eMEVS Change Password Change Account Info Provider Logout Help For Technical Support Provider Applications Area toll free 1 877 498 2783 The appication s listed below for authonzed use only Ckck on an application ink to access the application Provider cxn 4 rara n Unbsthar Ted ose of t 5 rA wats Provider Applications LAME DICAID COM Fact Sheet Restricted Provider Applications Medicaid Eligi on Oecument Provetes Appliratns Area Oste Modified 1 2403 3 1 6 Help Selecting the Help link at any point in the application provides you with this user manual 3 2 Other Important Features to Know 3 2 1 Dates and Calendar All searches must include a Plan Date also known as Date of Service and some searches include the Date of Birth of the recipient For those date fields you may enter the date in the fo
59. ysician Visit Office Urgent Care Co Payment Medicaid MEDICAID Benefit Co Pay is 0 for In Plan Network and Out of Plan Network Chiropractic Hospital Hospital Inpatient Hospital Outpatient Emergency Services Professional Physician Visit Office Urgent Care Date Revised 11 12 2015 19 eMEVS Application User Manual 4 1 2 Additional Third Party Liability TPL Information Prior to the 5010 transition there were isolated instances where TPL information was presented in addition to the carrier name address phone number policy holder policy number and group number as indicated in the example on page 18 above Regulations outlined in 5010 do not allow one carrier payer to provide any additional coverage information for another carrier payer The provider of services must contact the other carrier payer to obtain coverage information Thus providers inquiring through MEVS must contact inquire through the primary payer to get any additional information concerning the coverage for the recipient Date Revised 11 12 2015 20 eMEVS Application User Manual 4 2 Behavioral Health Transition into Bayou Health 2 0 Changes The following updates were made to the Response portion of the eMEVS application as per Behavioral Health Transition into Bayou Health 2 0 LIFT 10032 4 2 1 Hesponse Message For all eMEVS responses the following message noted in blue font will appear after the last message on the first pa

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