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AEVS Transactions (aev trn)

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AEVS Transactions (aev trn)

    aev trn

    AEVS: Transactions 1

This section describes how to access the Medi-Cal Automated Eligibility Verification System (AEVS) and

    complete eligibility verifications.

    Also included at the end of this section is the AEVS Response Log. This is designed to be photocopied for use in tracking AEVS transactions. The log was created as a convenient means of maintaining

    provider records only. It does not serve as valid proof of eligibility for claim submissions or appeals. It is

    recommended that you have this form available when you access AEVS.

GENERAL INFORMATION

Provider Identification Using a touch-tone telephone, dial 1-800-456-AEVS (2387) or

    Number (PIN) 1-800-541-5555. AEVS will respond with the following message:

    “Welcome to Medi-Cal. Please listen carefully as our menu has

    changed. For English press or say 1. Para Español marque

    dos.

    If you are a provider please press or say 1.

    If you are a beneficiary please press or say 2.

    For the Automated Eligibility Verification System please press

    or say 1.

    If you have a PIN please press or say 1.

    If you have a temporary PIN please press or say 2.

    Please enter your PIN followed by a pound sign (#).”

     Enter your Provider Identification Number (PIN).

     When the entered PIN is associated with both NPI and Legacy ID, the

     NPI will be given as the first option to select. In this case AEVS will

     respond with the following message:

     “If your Provider Number is (NPI), press 1.

     If your Provider Number is (Legacy ID), press 2.

     Or press 3 to re-enter your PIN.”

     The second option will be unavailable if only Legacy ID or NPI is

    associated with the entered PIN.

     If the PIN cannot be found on the Provider Master File, AEVS will

    prompt you to re-enter the correct PIN. If the PIN cannot be found

     after the third try, the call will be terminated with the following

     message:

    “We are unable to locate the Provider Identification Number.

    Please review the procedures in your AEVS User Guide or

    AEVS section of your provider manual.

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    If you have any questions concerning AEVS, please contact the

    Technical Help Desk at 1-800-541-5555. Denti-Cal providers

    should call 1-800-423-0507. Thank you for calling the

    Automated Eligibility Verification System. Good-bye.”

    Transaction Menu If the PIN can be verified by AEVS, you will receive the following

    prompt by provider type:

For Podiatrist, Acupuncturist, “For Eligibility Verification, press or say 1. For Share of Cost,

    Chiropractor, OT, Psychologist, press or say 2. To perform a Medi-Service transaction, press or Speech Pathologist, Audiologist say 3. For general information please visit us on the web at

    www.medi-cal.ca.gov.

    For all others “For Eligibility Verification, press or say 1. For Share of Cost,

    press or say 2. For Family PACT transactions, press or say 3.

    For general information please visit us on the web at

    www.medi-cal.ca.gov.

Recipient ID Number Press 1 to verify eligibility. You will then hear the following message:

    “If you know the beneficiary ID press or say 1.

    If not, press or say 2.”

    If you chose 1, you will hear the following message:

    “The beneficiary identification number can be found on the face

    of the Benefits Identification Card. If the beneficiary

    identification number includes a letter, and you need

    instructions on how to enter them, press or say 1.”

    If you press or say 1, you will hear the following:

    “To enter a letter, you must press three keys. First, press star

    (*), then press the key which has the letter you want, finally

    press one, two, three or four to indicate the position of the letter

    on that key. You enter numbers normally. For example, for A-

    2-3-Z, press star-two-one, two, three, star-nine-four. If you

    need to hear this message again, press or say 1.

    If you are ready to enter the beneficiary number, press or say 2.

    If it is all numeric or you know to enter letters, press or say 2.”

    If you chose 2, you will hear the following message:

    “Please enter the beneficiary’s identification number followed

    by the pound sign.

    You entered xxxxxxxxx.

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    If this is correct, press or say 1.

    If not, press or say 2.”

    Enter the recipient’s Medi-Cal identification number followed by the

    pound sign key (#). If there are any alpha characters in the number,

    press the star key (*) and number keys that correspond with the letter.

    Recipient Birth Date If the recipient ID number you enter is invalid, AEVS will prompt you

     to re-enter the number. If the recipient identifier is entered

     correctly, you will receive the following message:

     Please enter the two-digit month and four-digit year of the

    beneficiary’s birth. For example, June 1972, would be entered

    as 0-6-1-9-7-2.

     You entered .

     If this is correct, press or say 1.

     If not, press or say 2.”

    Verifying Newborn Infant If you are verifying eligibility for a newborn infant billing on the Eligibility mother’s ID number, enter the mother’s date of birth.

    Date of Service Please enter the date of service using the two-digit month, two-digit

    day and four-digit year. To enter today’s date press star:

     You entered .

     If this is correct, press or say 1.

     If not, press or say 2.

     If you press or say an invalid date you will hear the following message:

     That date is not valid. You must enter an eight-digit number

    only. Please enter the date of service.

    If you enter an invalid recipient date of birth you will hear the following

    message:

     The birth date you entered does not match our records.

     The date you entered is invalid. Please review the procedures in

    your AEVS User Guide or AEVS section of your provider

    manual. Denti-Cal providers should call 1-800-541-5555. Thank

    you for calling the Automated Eligibility Verification System.

    Good-bye ”

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    When a valid date is entered, AEVS will attempt to access the requested recipient’s eligibility information. At this point, you should be prepared to record the information provided by AEVS.

If the recipient’s eligibility cannot be verified, you will receive the

    following message:

    “No recorded eligibility for (month) (year) for beneficiary

    (ID number) with a birth date of (month) (year).”

    If the recipient has a Share of Cost (SOC), you will hear the following message:

    “This Medi-Cal beneficiary has a Share of Cost of (dollar

    amount) dollars. To hear this information again, press or say 1.

    Otherwise, press or say 2.”

    If you press or say 2 you will hear the following message:

    “This Medi-Cal beneficiary has a Share Cost of (dollar amount)

    dollars. To hear this information again, press or say 1.

    Otherwise press or say 2.”

If AEVS successfully retrieves the recipient’s eligibility information

    for the month that you requested and you pressed or said 2, you will receive the following message that will verify the recipient’s eligibility

    by giving you the first six letters of the last name and the first initial:

    “Thank you.

    The first six letters of the beneficiary’s name are _ _ _ _ _ _.

    The beneficiary’s first initial is _.

    The county code is _ _.

    The primary aide code is _ _.

    The first special aide code is _ _.

    Please call the health care plan for PCP information.

    The Eligibility Verification Confirmation number is (number).”

    After this message is spoken, please be prepared to record the recipient’s eligibility information on the AEVS Response Log.

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    Eligibility Message The following are examples of messages you may receive when Types AEVS provides you with the recipient eligibility information that you

     requested. A recipient may have more than one eligibility message

     spoken for each transaction. Be prepared to record the following

    information:

    “Beneficiary Medi-Cal eligible.

    Beneficiary is Medi-Cal eligible for dialysis and related services

    only, with _ _ percent obligation.

    Beneficiary is restricted to medical services related to

    pregnancy and family planning.

    The beneficiary has other health insurance coverage under

    code (OHC code) (OHC name) (carrier code). Scope of

    coverage is: (scope of coverage [COV] code[s]).”

     If available, you also may hear up to 10 occurrences of the carrier

     code and policy number. For a list of AEVS carrier codes, refer to

     AEVS: Carrier Codes for Other Health Coverage on the Medi-Cal

     website at www.medi-cal.ca.gov (click the “Publications” link and

     scroll to “Other Sections.”) to the Other Health Coverage (OHC)

     Codes Chart section in this manual.

     Note: Providers may view and download the online AEVS: Carrier

     Codes for Other Health Coverage section in Microsoft Word

     format.

    The Eligibility Verification Confirmation number is

    After all eligibility messages and eligibility verification confirmation

    (EVC) numbers are spoken for this transaction, you will receive the

    following message:

    “To hear this information again, press 1. Otherwise, press 2.”

    If you press 2, you will return to the main menu and hear the following

    message:

    “For Eligibility Verification, press or say 1. For Share of Cost,

    press or say 2. To perform a Medi-Service transaction, press or

    say 3. For general information please visit us on the web at

    www.medi-cal.ca.gov.”

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SHARE OF COST CLEARANCE OR REVERSAL

    Introduction The following process is used to access the Medi-Cal eligibility

     verification system to complete a Share of Cost (SOC) clearance or

     reversal transaction.

Provider Identification Using a touch-tone telephone, dial 1-800-456-AEVS (2387) or

    Number (PIN) 1-800-541-5555. AEVS will respond with the following message:

    “Welcome to Medi-Cal. Please listen carefully as our menu has

    changed. For English press or say 1. Para Español marque

    dos.

    If you are a provider, please press or say 1.

    If you are a beneficiary, please press or say 2.

    For the Automated Eligibility Verification System, please press or

    say 1.

    If you have a PIN, please press or say 1.

    If you have a temporary PIN, please press or say 2.

    Please enter your PIN followed by a pound sign (#).”

     Enter your Provider Identification Number (PIN).

    When the entered PIN is associated with both an NPI and Legacy ID

    number, the NPI will be given as the first option to select. In this case

    AEVS will respond with the following message:

     “If your Provider Number is (NPI), press 1.

     If your Provider Number is (Legacy ID), press 2.

     Or press 3 to re-enter your PIN.”

     The second option will be unavailable if only the Legacy ID or NPI is

    associated with the entered PIN.

     If the PIN cannot be found on the Provider Master File, AEVS will

    prompt you to re-enter the correct PIN. If the PIN cannot be found

     after the third try, the call will be terminated with the following

     message:

    “We are unable to locate the Provider Identification Number.

    Please review the procedures in your AEVS User Guide or

    AEVS section of your provider manual. Denti-Cal providers

    should call1-800-423-0507. Thank you for calling the Automated

    Eligibility Verification System. Good-bye.”

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    Transaction Menu If the PIN can be verified by AEVS, you will receive the following

    prompt by provider type:

For Podiatrist, Acupuncturist, “For Eligibility Verification, press or say 1. For Share of Cost,

    Chiropractor, OT, Psychologist, press or say 2. To perform a Medi-Service transaction, press or Speech Pathologist, Audiologist say 3. For general information please visit us on the web at

    www.medi-cal.ca.gov.

    For all others “For Eligibility Verification, press or say 1. For Share of Cost,

    press or say 2. For Family PACT transactions, press or say 3.

    For general information please visit us on the web at www.medi-

    cal.ca.gov.

     Press 2 to clear an SOC liability or reverse a previous clearance. You

    will then hear the following message:

    “To perform an update, press or say 1.

    To perform a reversal, press or say 2.”

    Recipient ID Number To perform an update, press 1. To perform a reversal, press 2.

     After you press 1 or 2, you will receive the following message:

     “The beneficiary identification number can be found on the face

    of the Benefits Identification Card.

     If the beneficiary identification number includes letters, and you

    need instructions on how to enter them, press or say 1.

     If you press or say 1 you will hear the following:

    To enter a letter, you must press three keys. First, press star

    (*), then press the key which has the letter you want. Finally

    press one, two, three or four to indicate the position of the letter

    on that key. You enter numbers normally. For example, for A-2-

    3-Z, press star-two-one, two, three, star-nine-four. If you need to

    hear this message again, press or say 1.

    If you are ready to enter the beneficiary number, press or say 2.

     If it is all numeric or you know how to enter letters, press or

     say 2.

    If you chose 2, you will hear the following message:

    “Please enter the beneficiary’s identification number.

    You entered .

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    If this is correct, press or say 1.

    If not, press or say 2.”

    Recipient Birth Date If the recipient ID number you enter is invalid, AEVS will prompt you

     to re-enter the number. If the recipient identifier is entered correctly,

     you will receive the following message:

    Please enter the two-digit month and four-digit year

    of the beneficiary’s birth. For example, June, 1972, would be

    entered as 0-6-1-9-7-2.”

    Verifying Newborn Infant If you are performing this transaction for services rendered to a SOC newborn infant billing on the mother’s ID number, enter the mother’s

    date of birth.

    Date of Service Please enter the date of service using two-digit day and four-digit

    year. To enter today’s date press star.

     “You entered .

     If this is correct, press or say 1.

     If not, press or say 2.”

     If you press or say an invalid date you will hear the following message:

     “That date is not valid. You must enter an eight-digit number

    only. Please enter the date of service .”

     If the date of service that you entered is invalid, AEVS will prompt you

    to re-enter the date.

    Note: If you have to re-enter the date of service, this is considered to

    be an additional inquiry and will count against the 10 inquiries

    you are allowed per call.

    Procedure Code If the date is entered correctly, you will receive the following message:

    “If the procedure code includes letters and you need help

    entering letters, press or say 1.

    If it is all numeric or you know how to enter letters, press or say

    2.”

    If you chose option 1, you will hear the following message:

    “If the procedure code includes letters and you need help entering

    letters, press or say 1.

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    If it is all numeric or you know how to enter letters, press or say

    2.”

    If you chose option 2 you will hear the following message:

    “Please enter a procedure code followed by the pound

    sign (#).

    You entered .

    If this is correct, press or say 1.

    To re-enter, press or say 2.”

    Total Billed Amount If you press 1, you will hear the following message:

    “Please enter the total claim charged amount including dollars

    and cents followed by a pound sign (#). For example, for

    twenty dollars and fifty cents would be, entered 2-0-5-0#”.

    If the amount you entered is invalid, AEVS will prompt you to re-enter the amount. If the amount is entered correctly, you will receive the following message:

    “You entered .

    If this is correct, press or say 1.

    To re-enter, press or say 2.”

    Case Number If you press 1, you will hear the following message:

    “If the case number includes letters, press or say 1.

    If it is all numeric, press or say 2.

    Or press pound to bypass the case number.”

    If you chose option 1 you will hear the following message:

    To enter a letter, you must press three keys. First, press star

    (*),then press the key which has the letter you want, finally

    press one, two, three or four to indicate the position of the letter

    on that key. You enter numbers normally. For example, for A-

    2-3-Z, press star-two-one, two, three, star-nine-four. If you

    need to hear this message again, press or say 1.

    If you are ready to make your entry, press or say 2.”

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    If you chose option 2 you will hear the following message:

    “Please enter the case number followed by the pound sign.”

     If the recipient has multiple cases, see “Multiple SOC Cases” on the

    following page.

    Clearance With SOC After you press the pound sign (#) for a recipient without multiple Liability Remaining cases, you will hear the following message if the recipient has

    additional liability:

    “The amount deducted was <000.00>.

     The amount of Share of Cost remaining is <000.00>.

     To enter a different procedure code, press or say 1.

     To enter a different case number, press or say 2.

     To return to the main menu, press or say 9.”

Clearance With No SOC After you press the pound sign (#) for a recipient without multiple

    Liability Remaining cases, you will hear the following message if the recipient’s

    Share of Cost is certified (no Share of Cost liability remaining):

    “The first six letters of the beneficiary’s name are _ _ _ _ _ _.

    The beneficiary’s first initial is _.

    The county code is _ _.

    The primary aid code is _ _.

    The first special aid code is _ _.

    The amount deducted was (amount). Share of Cost certified.

    The Eligibility Verification Confirmation number is (number).”

Multiple SOC Cases A recipient may have multiple cases for SOC clearance. You will hear

     the following messages based on the recipient case number status:

    This beneficiary is in multiple cases. Their case numbers are:

    

    

    

    .”

     If the recipient has more than four case numbers you will hear:

    “This beneficiary is in multiple cases. Their case numbers are:

    

    

    

    .

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