147 0 obj <>stream The eligibility response format is called the HIPAA 271 Health Care Eligibility Benefit Response (also known as 271 Eligibility Response). The purpose of EVS is to provide the most current information available regarding a recipient's MA eligibility and scope of coverage. Please enable scripts and reload this page. When a Pennsylvania ACCESS card is lost or stolen, the recipient should contact his/her County Assistance Office (CAO). It is vital that you verify the recipient's eligibility through the Eligibility Verification System (EVS) each time the recipient is seen. Proudly founded in 1681 as a place of tolerance and freedom. e ™ Eligibility Verification System (EVS) before billing a MA beneficiary. Provider Electronic Solutions Software is available free-of-charge by downloading from the OMAP PROMISe™ … This is pursuant to the 18 visit limit, during the July 1 through June 30 state fiscal year service period. Prior to performing services, you should review the MA Bulletins related to SelectPlan. For example, if you perform an inquiry using the 10-digit recipient ID number and the two-digit card issue number, and either one of those data elements is incorrect (most likely the card issue number, as you must use the most current card issue number), you will receive an ineligible response. A replacement card should be received in a maximum of seven days. Keystone State. For additional information, please refer to Medical Assistance Bulletin 99-07-10 or the 18-visit limit procedure code chart which can be found on the department's website at 18 Visit Limit Chart, 8. The PROMISe™ Eligibility Verification System enables a provider to determine a Medical Assistance recipient’s eligibility as well as their scope of coverage. Step 2 - Send us an e-mail — promise@pa.gov Step 3 - Write to us — If you do not have access to e-mail, please write to us. h��Ymo�8�+�K��Z|Y���h{�&�Y@�5֥�%�a�����gHɖŕ���p0��9$��3� If not, EVS indicates the number of countable office visits, clinic and home visits remaining within the scope of benefits for adult MA and adult GA recipients. Prior to performing services, you should review the MA Bulletins related to SelectPlan. %%EOF EVS will also provide details on the recipient's third-party resources and managed care plan when applicable. The MHX category is only used for tracking mental health service, encounter claims for County Mental Health Funded Base Programs. elements are most likely accurate. information returned from EVS is consistent across all methods of submission; however, depending upon the information submitted on the inquiry, the results may be different. However, you should not assume that a patient is eligible whether they are able to present a valid identification card or not. Pennsylvania Medical Assistance (MA) PROMISe™ Eligibility Verification System (EVS), Develop a skilled workforce that meets the needs of Pennsylvania's business community, Provide universal access to high-quality early childhood education, Provide high-quality supports and protections to vulnerable Pennsylvanians. This redesigned card has a background photo of the PA State Capitol building framed by cherry blossom branches. h�bbd```b``��� ��?����,w�"+@$�2�*�*�`�\0yD����H�D�x�d|"]�A"��@��@d�- ��ˉ� �{`�00�h� �.� The dial-up (modem) Bulletin Board System (BBS) solution for electronic file management was decommissioned at the end. In addition, the newly redesigned EBT card has entered into circulation. The PROMISe™ Eligibility Verification System (EVS) enables you to determine a Medical Assistance recipient’s eligibility as well as their scope of coverage. The interim card contains the same Recipient Number and Card Issue Number as the previous ACCESS card. HCB 15 is SelectPlan for Women. How can I determine if a recipient is eligible for Medical Assistance (MA)/Medicaid if they do not have their ACCESS Card?All eligible recipients (including those recipients enrolled in a managed care organization [MCO]) will have a permanent identification card that identifies their eligibility for covered MA services. Providers and other approved agencies that submit electronic requests in the 270 format will receive an EVS response with eligibility information in the 271 format. The PROMISe™ Eligibility Verifi cation System (EVS) enables you to determine a participant’s Medical Assistance eligibility, as well as the participant’s scope of coverage. Batch EVS capabilities have been built into the, Providers have the option to submit individual EVS requests by telephone. The Eligibility Verification System . Recipients who are eligible for medical benefits only will receive the yellow ACCESS card. All Medical Assistance (MA) providers should check the PROMIS. A replacement card should be received in a maximum of seven days. The eligibility request format is called the HIPAA 270 Health Care Eligibility Benefit Inquiry format (also known as 270 Eligibility Inquiry). This ensures recipients of uninterrupted medical services. The Eligibility Verification System (EVS) has been enhanced to inform providers when a recipient has exceeded the 18 visit limit. Please enable scripts and reload this page. In the event that a recipient is eligible for health benefits associated with other programs, the recipient will be authorized for those services under a separate healthcare benefits package. This program provides coverage of selected family planning services, pharmaceuticals, and. 0 Recipient information is listed on the front of the card and includes the full name of the recipient, a 10-digit recipient number, and a 2-digit card issue number. If, however, you use the recipient's social security number and date of birth, you may receive an eligible response because both of these elements are most likely accurate. �g�k&�Dm�p�eR���ƣ�L ��(�h{M�`�AWH�B�H֡AU�̢,�0���K8Z�d�q�������2(IA�cHJ@+IŤ�%�F#�Vi���d,Sܐ���ka�,i����V�AK �9�%�dZ��J��Y��L+K���#-�t�'l��S�3#9 �$��0lL��Z0�i�8H+HF+f��!ͬ�CІYK;Ֆa7��~���\g�~��n�.������3���4��l��?֫j2]�9Y5eSM���*{yr��]C��q4/��>TwM�x��إV�6zbN�NB(��f�����\V������džV}[��sr����e�����!Y��K��5��ݕL�H��b�qb>$8�Q�_�i��g�/����n���F��U����t:�X�����C�HF'���u7�������Ĵ�y�����?5�I�]TI�k���_�W�McLr�I�����CD[P�C��|��,k솺�i )�jʇ��tv�P1����)6�e��/�*�Ep���o00��A�-�E3_f��K���. If not, EVS indicates the number of countable office visits, clinic and home visits remaining within the scope of. If, however, you, use the recipient's social security number and date of birth, you may receive an eligible response because both of these. Instructions on how to register and use the PROMISe™ Internet can be found in the PROMISe™ Internet User Manual. endstream endobj 80 0 obj <>/Metadata 7 0 R/Pages 77 0 R/StructTreeRoot 16 0 R/Type/Catalog>> endobj 81 0 obj <>/MediaBox[0 0 612 792]/Parent 77 0 R/Resources<>/Font<>/ProcSet[/PDF/Text]/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 82 0 obj <>stream 6. devices for women who are not otherwise eligible for MA. Again, it is often easier for us to research your specific problem if you write us. The eligibility request format is called the HIPAA 270 Health Care Eligibility Benefit Inquiry format (also known as 270 Eligibility Inquiry). In the event that a recipient is eligible for health. benefits associated with other programs, the recipient will be authorized for those services under a separate healthcare benefits package. Payment will not be made for ineligible recipients. However, you should not assume that a patient is eligible whether they are able to present a valid identification card or not. The interim card contains the same Recipient Number and Card Issue Number as the previous ACCESS card. 5. %PDF-1.5 %���� Providers and other approved agencies that submit electronic requests in the 270 format will receive an EVS response with eligibility information in the 271 format. The EVS enables providers to determine a MA beneficiary’s eligibility. Citizenship— Medical Assistance is available to United States citizens, refugees, and certain lawfully admitted aliens. It is important to verify and submit accurate recipient information when checking eligibility via the EVS. 79 0 obj <> endobj Pennsylvania Medical Assistance (MA) PROMISe™ Eligibility Verification System (EVS) Providers can submit individual web interactive EVS requests via the PROMISe™ Internet. This is pursuant to the 18 visit limit, during the July 1 through June 30 state fiscal year service period. 7. You may be trying to access this site from a secured browser on the server. If not, EVS indicates the number of countable office visits, clinic and home visits remaining within the scope of benefits for adult MA and adult GA recipients. EVS should be accessed on the date the service is provided since the recipient's eligibility is subject to change. If a card is needed immediately, an interim paper card can be issued by the CAO. For example, if you perform an inquiry using the 10-digit recipient ID number and the two-digit card issue number, and either one of those data elements is incorrect (most likely the card issue number, as you must use the most current card issue number), you will receive an ineligible response. Proudly founded in 1681 as a place of tolerance and freedom. Will providers still be able to use the PROMISe™ Eligibility Verification System to verify Both formats may also be referenced by the 3-digit transaction number, 270 and 271. The original EBT ACCESS card is blue and green in color with the word "ACCESS" printed in yellow letters. 3. Providers can access EVS through the 2. Providers can submit individual web interactive EVS requests via the, Batch EVS requests need to be submitted utilizing the ANSI X12 v5010 270/271 transaction sets. Is there a manual available on how to read the printout and actually use it via modem submission?The dial-up (modem) Bulletin Board System (BBS) solution for electronic file management was decommissioned at the end of May 2011. A. Pennsylvania Licensing System. endstream endobj startxref For more information related to EVS, refer to Provider Quick Tip #11 at: http://www.dhs.pa.gov/publications/forproviders/QuickTips/ Q4. The MHX category is only used for tracking mental health service encounter claims for County Mental Health Funded Base Programs. The EBT card is issued to MA recipients who receive cash assistance and/or food stamps as well as medical services, if eligible. Using the COMPASS questionnaire, those who wish to apply for benefits can see if they or anyone in their household may get approved. On this version of the card, the client's full name and card number are on the bottom left, while the top left corner has a keystone and 'Pennsylvania', and the upper right-hand corner has the letters 'EBT'. The recipient is showing eligible for Healthcare Benefit package (HCB) 15, what services are they covered for?HCB 15 is SelectPlan for Women. What if the EVS response displays that a recipient only has service program category MHX and service program EPOMS?The recipient is not MA eligible if they only have EPOMS. Do not assume that a participant is eligible for Medical Assistance because he/she has an ACCESS or CHC health plan ID card. PROMISe™ Provider portal, through the h�b```a``������0�A���2�@�������aT\��'��)F���p V ��3���(���2�=���� � The name, age, and gender of … We are having difficulty reading the EVS printout. You may be trying to access this site from a secured browser on the server. The card issue number is voided to prevent misuse when the new card is issued. A recipient’s eligibility is subject to change;