Because the new gray-colored card will not be issued prior to September 8, 2009, current recipients will be issued an old version (blue, pink, green, or buff-colored) of the monthly card for September. Individuals approved for Medicaid prior to September 8, 2009, will also be issued an old version of the monthly cards. Therefore, during the month of September, providers will continue to see the blue, pink, green, and buff-colored cards and may also begin to see the new gray-colored card. Old monthly cards with September or earlier eligibility dates will continue to serve as proof of eligibility for the months shown on the card.
Example of New MID Card
Additional information is available through the Medicaid Bulletin:
Notice of Medicaid Identification Card Changes
Notice of Possible Medicaid Identification Card Changes
Attention: All Providers
Notice of Medicaid Identification Card Changes
Upon approval of the State budget, the N.C. Medicaid Program will begin issuance of one Medicaid identification (MID) card per year to each recipient. The effective date of this change may be as early as September 8, 2009. The annual cards will be printed on gray card stock; DMA will no longer have blue, pink, green, and buff-colored MID cards. The cards will include the individual’s name, MID number, and CCNC/CA primary care provider information (if applicable).
This change means that the MID card will no longer serve as proof of recipient eligibility. At each visit, providers must verify the cardholder’s:
Identity (if an adult)
Current eligibility
Medicaid benefit category
CCNC/CA primary care provider information
Other insurance information
However, once eligibility has been verified during a particular month, the provider may assume that the cardholder’s identity, eligibility, PCP and other insurance information remains valid for the remainder of that month.
To verify eligibility, a provider can choose to use the “real-time” Eligibility Verification System (EVS) to submit and receive the HIPAA 270/271 transactions through an approved Value Added Network (VAN), use the batch EVS to submit and receive the HIPAA 270/271, or call the EDS Automated Voice Response (AVR) system at 800-723-4337.
For additional information on health eligibility benefits inquiries and responses, refer to the article titled Recipient Eligibility Benefit Inquiry and Response
The methods listed above will not only serve to verify eligibility, but also to inform the provider as to whether the recipient is entitled to any special services, such as the Program of All-inclusive Care for the Elderly (PACE) or the Community Alternatives Program (CAP), or is enrolled in a restrictive program, such as Family Planning Waiver or Medicaid for Pregnant Women. Recipients enrolled in PACE receive their medical care exclusively through the PACE organization. When using the AVR system, it is therefore important that providers listen to the entire recorded message and follow prompts as directed or important parts of eligibility information may be missed.
An exception to the one-card-per-year rule will be made for those managed care recipients who change their primary care physician and for those recipients who legally change their name. Recipients will also be able to ask the county department of social services to submit requests for replacement cards, if needed.
Medicaid Eligibility Unit
DMA, 919-855-4000
Automated Voice Response (AVR) System Provider Inquiry Instructions
Recipient Eligibility Benefit Inquiry and Response
Sample of New Medicaid Identification Card
In September 2009 the N.C. Medicaid Program will implement North Carolina Electronic Claims Submission/Recipient Eligibility Verification Web Tool. This tool will allow providers to access electronic recipient eligibility via the North Carolina Electronic Claims Submission (NCECS) Webtool. https://webclaims.ncmedicaid.com/ncecs/
Use of this tool will allow providers to immediately verify recipient information such as
Current eligibility
Medicaid benefit category
Medicare participation
CCNC/CA (Carolina ACCESS) participation
Transfer of asset information
Other insurance information
This will be the same information that providers receive today through the Automated Voice Response (AVR) system but quicker and easier. In order to use this tool, providers must have access to the NCECSWeb Tool. DMA encourages you to begin immediately the process of obtaining this access.
Providers who currently have an NCECSWeb logon ID and password can utilize this same logon information to access recipient eligibility verification. You do not need to take any further action.
Providers who do not currently have access to the NCECSWeb must take the following action.
Step One:
Submit a completed and signed Electronic Claims Submission (ECS) Agreement to CSC. (Refer to the NC Tracks website at http://www.nctracks.nc.gov/provider/forms for a copy of the form and instructions.
*Providers who have previously submitted the ECS Agreement do not need to resubmit the form.
Step Two:
Contact the EDS Electronic Commerce Services Unit (1-800-688-6696 or 919-851-8888, option 1) to obtain instructions and a logon ID and password for the NCECSWeb Tool.
For additional information on verifying recipient eligibility refer to the Basic Medicaid Billing Guide on DMA's website at http://www.ncdhhs.gov/dma/basicmed/. For detailed information on the NCECSWeb Tool, refer to the September 2009 Special Bulletin, North Carolina Electronic Claims Submission/Recipient Eligibility Verification Web Tool Instruction Guide, on DMA's website at
No comments:
Post a Comment