NEW YORK STATE PROGRAMS

MEVS INSTRUCTIONS FOR COMPLETING A TELEPHONE TRANSACTION

·   Be sure to convert all alpha characters to numeric prior to dialing.

·   Press * (asterisk key) once to clear a mistake; or to repeat a response.

·   Once you are familiar with the prompts and wish to make your entries without waiting for the prompts, just continue to enter the data in the proper sequence. As in all transactions (prompted or unprompted), press the # key after each entry.

·   For assistance or further information on input or response messages, call the Provider Services staff at 1-800-343-9000.

·   For some prompts, if entry is invalid, the ARU will repeat the prompt. This allows you to correct the entry without re-keying the entire transaction.

·   The call is terminated if excessive errors are made.

·   For description or clarification of any response, see the MEVS Provider Manual.

·   Nonapplicable prompts may be bypassed by pressing #.

·   To begin the transaction, Dial 1-800-997-1111

ALPHA CONVERSION CHART

A = 21   H = 42    O = 63   V = 83

B = 22    I = 43     P = 71    W = 91

C = 23    J = 51    Q = 11   X = 92

D = 31    K = 52    R = 72    Y = 93

E = 32    L = 53    S = 73    Z = 12

F = 33    M = 61   T = 81

G = 41   N = 62    U = 82
 
VOICE PROMPT                                             ACTION/INPUT

NEW YORK STATE MEDICAID                       None

IF ENTERING ALPHANUMERIC (CIN)

IDENTIFIER, ENTER NUMBER 1                      Enter 1 or 2

IF ENTERING NUMERIC IDENTIFIER               Press #.

(ACCESS #) ENTER NUMBER 2

ENTER IDENTIFICATION NUMBER                 Enter the client’s converted alphanumeric Medicaid number (CIN) or numeric access number. Press #.

ENTER NUMBER 1 FOR SERVICE

AUTHORIZATION OR NUMBER 2 FOR          Enter 1 or 2. Press #.

ELIGIBILITY INQUIRY

ENTER SEQUENCE NUMBER                          If the Identification Number entry was a Medicaid number (CIN), enter the two-digit sequence number.

                                                                        No entry is necessary if the numeric Access Number was entered. Press # to bypass the prompt.

ENTER DATE                                                   Press # for today’s date or enter MMDDYY for verification on a previous date of service. Press #.

ENTER PROVIDER NUMBER                           Enter Provider Identification Number. Press #.

ENTER SPECIALTY CODE                             If applicable, enter the three-digit specialty code and press #, or press # to bypass.

ENTER REFERRING PROVIDER                      Enter the Medicaid provider number of the

NUMBER                                                         referring provider. Press #.

                                                                        If the client is not a referral, press # to bypass this prompt.

ENTER FIRST CO-PAYMENT TYPE               Enter the converted co-payment type or press # to bypass the rest of the co-payment prompts.

ENTER CO-PAYMENT UNITS                         Enter the number of units being rendered or press # to bypass the rest of the co-payment prompts.

ENTER SECOND CO-PAYMENT TYPE           Enter the converted co-payment type or press # to bypass the rest of the co-payment prompts.

ENTER CO-PAYMENT UNITS                         Enter the number of units being rendered or press # to bypass the rest of the co-payment prompts.

RESPONSES (contd.)

TELEPHONE RESPONSE                                DESCRIPTION/COMMENTS

PERINATAL FAMILY                                     Client is eligible to receive a limited package of benefits. See MEVS Provider Manual for excluded services.

PRESUMPTIVE ELIGIBLE LONG-                  Client is eligible for all Medicaid services except

TERM/HOSPICE                                              hospital based clinic services, hospital emergency room services, hospital inpatient services, and bed reservation.

PRESUMPTIVE ELIGIBILITY                          Client is eligible to receive all Medicaid services

PRENATAL A                                                 except inpatient care, institutional long-term care, alternate level care, and long-term home health care.

PRESUMPTIVE ELIGIBILITY                          Client is eligible to receive only ambulatory

PRENATAL B                                                  prenatal care services. See MEVS Provider Manual for excluded services.

ANNIVERSARY MONTH OCTOBER               This is the beginning month of the client’s benefit year.

CATEGORY OF ASSISTANCE S                    Client is enrolled in the SSI assistance program.

MEDICARE PART A                                       Client has only Part A Medicare.

MEDICARE PART B                                        Client has only Part B Medicare.

MEDICARE PARTS A and B                          Client has both Parts A and B.

MEDICARE PARTS A & B & QMB                 Client has Part A and B Medicare coverage and is a Qualified Medicare Beneficiary (QMB).

MEDICARE PART A & QMB                          Client has Part A Medicare coverage and is a Qualified Medicare Beneficiary (QMB).

MEDICARE PART B & QMB                           Client has Part B Medicare coverage and is a Qualified Medicare Beneficiary (QMB).

MEDICARE QMB ONLY                                  Client is a Qualified Medicare Beneficiary (QMB) Only.

HEALTH INSURANCE CLAIM NUMBER        Health Insurance Claim number.

XXXXXXXXXXXX

HEALTH INSURANCE CLAIM NUMBER        Health Insurance Claim number is not on file.

NOT ON FILE

INSURANCE COVERAGE CODE 21:               Insurance and Coverage Codes equal the

DENTAL, PHYSICIAN, INPATIENT                 Insurance carrier and the scope of benefits.

EXCEPTION CODE 35                                    Client’s exception and/or restriction code.

NO CO-PAYMENT REQUIRED                        Client is under 21 or exempt from co-payment and co-payment data has been entered.

CO-PAYMENT REQUIREMENTS MET           Client has reached his/her co-payment maximum.

ON MM/DD/YY

AT SERVICE LIMIT                                        The client has reached his/her limit for that particular service category. No service authorization is created.

 

 

VOICE PROMPT                                             ACTION/INPUT

ENTER THIRD CO-PAYMENT TYPE               Enter the converted co-payment type or press # to bypass the rest of the co-payment prompts.

ENTER CO-PAYMENT UNITS                         Enter the number of units being rendered or press # to bypass the rest of the co-payment prompts.

ENTER FOURTH CO-PAYMENT TYPE           Enter the converted co-payment type or press # to bypass the rest of the co-payment prompts.

ENTER CO-PAYMENT UNITS                         Enter the number of units being rendered or press # to bypass the rest of the co-payment prompts.

ENTER NUMBER OF SERVICE UNITS            Enter the total number of service units rendered. Press #.

IF YOU ARE A DESIGNATED POSTING         If you are a designated Posting Provider, Enter

PROVIDER, ENTER NUMBER OF LAB            the total number of Lab tests being ordered and

TESTS YOU ARE ORDERING                          Press# or Press # to bypass.

IF YOU ARE A DESIGNATED POSTING         If you are a designated Posting Provider, Enter

PROVIDER, ENTER NUMBER OF                    the total number of prescriptions or over the

PRESCRIPTIONS OR OVER THE                    counter items being ordered and Press #,

COUNTER ITEMS YOU ARE ORDERING        or Press # to bypass.

ENTER ORDERING PROVIDER                       Enter the MMIS Provider Identification Number or

NUMBER                                                         License Type and License Number of the ordering provider, if applicable. Press # or Press # to bypass.

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RESPONSES

TELEPHONE RESPONSE                                DESCRIPTION/COMMENTS

MEDICAID NUMBER AA22346D                    The response begins with the client’s eight-digit Medicaid CIN.

COUNTY CODE XX                                         Client’s two-digit county code.

ELIGIBLE CAPITATION GUARANTEE           Indicates guaranteed status under a Prepaid Capitation Program (PCP).

ELIGIBLE EXCEPT LONG TERM CARE         Client is eligible to receive all Medicaid services except for Long Term Care.

ELIGIBLE ONLY FAMILY PLANNING            Client is eligible for Medicaid covered family

SERVICES                                                       planning services.

ELIGIBLE ONLY OUTPATIENT CARE           Client is eligible for all ambulatory care, including prosthetics, no inpatient coverage.

ELIGIBLE PCP                                               Client covered by a Prepaid Capitation Program (PCP) as well as eligible for limited fee-for-service benefits.

EMERGENCY SERVICES ONLY                     Client is eligible for emergency services only.

FAMILY HEALTH PLUS                                 Client is enrolled in the Family Health Plus Program

                                                                        (FHP).

MEDICAID ELIGIBLE HR UTILIZATION         Client is eligible to receive all Medicaid services

THRESHOLD                                                   with prescribed limits. A service authorization must be obtained for services limited under Utilization Threshold.

MEDICAID ELIGIBLE                                      Client is eligible for all benefits.

MEDICARE COINSURANCE AND                   Client is eligible for payment of Medicare

DEDUCTIBLE ONLY                                        coinsurance and deductibles only.

 

RESPONSES (contd.)

TELEPHONE RESPONSE                                DESCRIPTION/COMMENTS

DUPLICATE – UT PREVIOUSLY                    Request is a duplicate of a previously approved

APPROVED                                                     service authorization.

PARTIAL APPROVAL XX SERVICE              Indicates that the full complement of requested

UNIT(S), XX LAB UNIT(S), XX                       services relative to Post and Clear processing is

PHARMACY UNIT(S) POST AND                  not available. The XX represents the number of

CLEAR                                                            services approved/available.

PARTIAL APPROVAL XX SERVICE              Indicates that the full complement of requested

UNIT(S), XX LAB UNIT(S), XX                       services relative to Utilization Threshold

PHARMACY UNIT(S) UTILIZATION              processing is not available. The XX represents

THRESHOLD                                                   the number of services approved/available.

SERVICE APPROVED NEAR LIMIT               The service authorization has been granted and

XX SERVICE UNIT(S), XX LAB UNIT(S),       recorded. The client has almost reached his/her

XX PHARMACY UNIT(S)                                service limit for that particular category.

SERVICE APPROVED UTILIZATION             The service units requested are approved.

THRESHOLD XX SERVICE UNIT(S),

XX LAB UNIT(S), XX PHARMACY UNIT(S)

SERVICES APPROVED POST AND               The ordering provider has posted services and the

CLEAR XX SERVICE UNIT(S), XX LAB         units have been approved.

UNIT(S), XX PHARMACY UNIT(S)

FOR DATE MMDDYY                                      The date for which services were requested will be heard when message is complete.

                                                                        Press # to repeat entire message.

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ERROR RESPONSES

TELEPHONE RESPONSE                                DESCRIPTION/COMMENTS

CALL 800-343-9000                                      When certain conditions are met (ex: multiple responses), you need to call the Provider Services staff for additional data.

DECEASED ORDERING PROVIDER                The Ordering Provider is deceased.

DISQUALIFIED ORDERING                             The Ordering Provider is identified as excluded/

PROVIDER                                                      disqualified and cannot prescribe.

EXCESSIVE ERRORS, REFER TO                   Too many invalid entries. Refer to the input data

MEVS MANUAL OR CALL 800-343-            section or call 1-800-343-9000.

9000 FOR ASSISTANCE

INVALID ACCESS METHOD                         The received transaction is classified as a Provider Type/Transaction Type Combination that is not allowed to be submitted through the telephone.

INVALID ACCESS NUMBER                          Incorrect access number.

INVALID CARD THIS RECIPIENT                  Client has used an invalid card.

INVALID CO-PAYMENT                                Invalid number of digits or number doesn't covert to an alpha character. To proceed, re-enter the data in the correct format.

 

ERROR RESPONSES (contd.)

TELEPHONE RESPONSE                                DESCRIPTION/COMMENTS

INVALID CO-PAYMENT, REFER TO              The Data entered is not a valid Co-payment value.

MEVS MANUAL

INVALID DATE                                               Illogical date or a date which falls outside of the allowed inquiry period of 24 months.

INVALID ENTRY                                             An invalid number of digits was entered for service units.

INVALID IDENTIFICATION NUMBER             The client identification number not valid.

INVALID LICENSE TYPE                                License type not valid.

INVALID MEDICAID NUMBER                        Medicaid number (CIN) not valid.

INVALID MENU OPTION                                An invalid entry was made when selecting the identifier type.

INVALID ORDERING PROVIDER                    Ordering Provider Identification Number or License

NUMBER                                                         number entered was not found on file.

INVALID PROVIDER NUMBER                       Provider Identification Number invalid.

INVALID REFERRING PROVIDER                   Referring Provider Identification Number invalid.

NUMBER

INVALID SEQUENCE NUMBER                       The sequence number entered is not valid or not current.

INVALID SPECIALTY CODE                          The specialty code was either entered incorrectly, or not associated with the provider’s category of service, or the provider is a clinic and a required specialty was not entered.

MCCP RECIPIENT NO                                    Client is restricted. Services must be provided,

AUTHORIZATION                                           ordered, or referred by the primary provider.

NO COVERAGE EXCESS INCOME                 Client has an income in excess of the allowable levels and must spenddown the excess in order to be eligible.

NO COVERAGE PENDING FAMILY                Client is waiting to be enrolled into a Family Health

HEALTH PLUS                                                Plus Managed Care Plan.

NO SERVICE UNITS ENTERED                       No entry was made and the units are required for                                                                         this transaction.

NOT MEDICAID ELIGIBLE                              Client is not eligible for benefits on the date of service entered.

PRESCRIBING PROVIDER                              License number is not active for the date of

LICENSE NOT IN ACTIVE STATUS               service entered.

PROVIDER INELIGIBLE FOR                          The category of service for the Provider

SERVICE ON DATE PERFORMED                  identification number submitted in the transaction

                                                                       is inactive or invalid for the date of service

                                                                       entered.

PROVIDER NOT ELIGIBLE                             The verification was attempted by an inactivated

                                                                       or disqualified provider.

 

ERROR RESPONSES (contd.)

TELEPHONE RESPONSE                                DESCRIPTION/COMMENTS

PROVIDER NOT ON FILE                                The Provider Identification Number entered is not identified as a Medicaid enrolled provider.

RECIPIENT NOT ON FILE                               Client identification number (CIN) is not on file. The number is either incorrect or the client is no longer eligible and the number is no longer on file.

REENTER ORDERING PROVIDER                   Ordering provider number or license number has an

NUMBER                                                         incorrect format (wrong length or characters in the wrong position).

RESTRICTED RECIPIENT NO                          Enter the MMIS Provider Identification Number to

AUTHORIZATION                                            whom the client is restricted.

SERVICES NOT ORDERED                             The ordering provider did not post the services you are trying to clear.

SSN ACCESS NOT ALLOWED                      The provider is not authorized to access the system using a social security number.

SSN NOT ON FILE                                          The entered nine-digit number is not on the Client Master file.

SYSTEM ERROR #                                          A network problem exists. Call 1-800-343-9000 with the error number.

THE SYSTEM IS CURRENTLY                       System is unavailable. After hearing this message

UNAVAILABLE. PLEASE CALL                    you will be disconnected.

800-343-9000 FOR ASSISTANCE

 

 

NEW YORK STATE PROGRAMS

MEVS INSTRUCTIONS USING VERIFONE Omni 3750

 

·          ENTER key must be pressed after each field entry.

·          For assistance or further information on input or response messages, call Provider Services staff, 1-800-343-9000.

·          To add provider numbers to your terminal, call 1-800-343-9000. (Please maintain a listing of provider numbers and associated values.)

·          To enter a number, press the key with the desired number.

·          To enter a letter, press the key with the desired letter, and then press the alpha key until the letter appears in the display window.

PROMPT DISPLAYED                                    ACTION/INPUT

                                                                        To begin, press the RED key, press the F4 key to start the verification.

ENTER CARD OR ID                                        If you are using the client’s access number then swipe the card through reader, or key the access number then press the ENTER key.

                                                                        If you are using the Client’s Medicaid number (CIN), enter the Medicaid number and press the ENTER key.

ENTER TRAN TYPE                                        One of the following must be entered:

                                                                        1    Service Authorization and Eligibility inquiry.

                                                                        2    Eligibility inquiry only.

                                                                        3    Authorization Confirmation.

                                                                        4    Authorization Cancellation.

6      Dispensing Validation System (DVS) Request.

7      Service Authorization and Eligibility inquiry.

     (Lab & Pharmacies)

                                                                        Press the ENTER key.

Note:     Depending on which Tran Type you select, the following prompts may not appear in the order in which they are listed.

ENTER SEQ #                                                  If you are using the Medicaid Number (CIN), enter the two-digit sequence number and press the ENTER key. Note: This prompt will not appear if the Access number was entered as it contains the sequence number.

ENTER DATE                                                   Press ENTER for today’s date or enter MMDDCCYY for verification on a previous date of service. Press the ENTER key.

SELECT PROVIDER                                        If you see this prompt there are multiple provider numbers programmed into this terminal. Enter the appropriate number associated with your Provider Identification Number or enter an eight-digit MMIS Provider Identification Number and press the ENTER key (To add numbers call 1-800-343-9000)

ENTER TAXONOMY CODE                             This code is used for classifying health care providers according to provider type or practitioner specialty.

SERVICE TYPE                                               Enter the code identifying the type of service you are providing.

ORDERING PRV #                                           Enter the MMIS Provider Identification Number or license type and State license number of the ordering provider, if applicable. Press the ENTER key.

 

PROMPT DISPLAYED                                    ACTION/INPUT

REFERRING PRV #                                          Enter the Medicaid provider number of the referring provider. For Restricted Clients, enter their Primary Provider’s number. Press the ENTER key.

COPAY EXEMPT                                           If the service you are rendering does not require co-payment, or if the client is exempt or has met their co-payment maximum responsibility, enter 1 for yes. If the client is not exempt from co-payment, enter 2 for no. Note: Bypassing this prompt will enter a 2 for no.

# SERVICE UNITS                                           Enter the total number of service units.

                                                                       Press the ENTER key.

Note:   The following two prompts are required for DVS transactions only and will only appear

when Tran Type 6 is entered.

ENTER ITEM/NDC #                                        Enter the five-digit New York State alpha/numeric item code of the item being dispensed. For some items, if instructed by New York State, the Eleven-digit National Drug Code may be entered.

                                                                        For Dental DVS: Enter a constant value of ‘D’; the five character Dental procedure code; and a two-digit tooth number, a one character primary tooth, or two character tooth quadrant/arch.

                                                                        Press the ENTER key.

ENTER QUANTITY                                          Enter the total number of units dispensed for the current date of service only.

                                                                        For Dental DVS: Enter the number of times the procedure was performed.

                                                                        Press the ENTER key.

Note:     If you are using Tran Type 7:

# LAB TESTS                                                 If you are a lab provider, enter the number of lab tests you are performing and press the ENTER key. Bypass by pressing the ENTER key.

# Generic/OTC Rx                                        If you are a Pharmacy provider, enter the number of generic prescriptions or over the counter items you are dispensing and press the ENTER key. Bypass by pressing the ENTER key.

# BRAND RX                                                   If you are a Pharmacy, enter the number of brand prescriptions you are dispensing and press the ENTER key. Bypass by pressing the ENTER key.

# OF RX SUPPLIES                                         Enter the number of supplies you are dispensing and press the ENTER key. Bypass by pressing the ENTER key.

Note:   If you are a POST and CLEAR Provider, enter the appropriate data for the following two prompts.

# LAB TESTS                                                 Enter the number of lab tests you are ordering. Press the ENTER key.

#RX/OTC                                                         Enter the number of prescriptions or over the counter items. Press the ENTER key.

THIS ENDS THE INPUT DATA SECTION.       The VeriFone will now dial into the MEVS system and display these processing messages:

DIALING, WAITING FOR ANSWER,

CONNECTED, TRANSMITTING,

RECEIVING, and PROCESSING

 

RESPONSES

The MEVS receipt presents information in two sections:

·          Input, which always begins with TODAY’S DATE and displays all information entered into the terminal.

·          Response, which always begins with PROV NO.: and contains all fields returned by MEVS.

VERIFONE RESPONSE                                    DESCRIPTION/COMMENTS

PROV NO.:                                                      The eight-digit MMIS Provider Identification Number.

DATE SVC:                                                     The date for which services were requested.

MEDICAID ID:                                                 The Medicaid number (CIN) is displayed on the receipt if the client is identified. If the client cannot be identified, the information entered will be displayed.

HIC NO:                                                           Health Insurance Claim number for Medicare.

DOB:                                                                The client’s date of birth.

GENDER:                                                         The client’s gender:

M = Male

F = Female

U = Unborn

CNTY/OFF:                                                      The two digit county code is displayed for Upstate clients, for Downstate clients, the 3-digit NYC office code is displayed.

ANNIV DT:                                                      The date the client’s current benefit year began.

MSG:                                                               If applicable, the client’s Category of Assistance or exception codes will be returned.

-----------------------------------

ELIG REQUEST REJECT                                 This section is displayed when the eligibility

-----------------------------------                         request cannot be validated

Rej Reason Cd:                                             This field displays the Reject Reason codes.

                                                                        Please see the REJECT CODES section for details.

Folw-Up Act Cd:                                           C = Please Correct and Resubmit

                                                                        P = Please Resubmit Original Transaction

INFO #:                                                            Call the telephone number displayed for more                                                                         information.

-----------------------------------

SERV REQUEST REJECT                                This section is displayed when a

-----------------------------------                          Service Authorization (SA) or Dispensing

Validation System (DVS) request cannot be

processed or the client is ineligible.

Rej Reason Cd:                                             This field displays the Reject Reason codes. Please see the REJECT CODES section for details.

Folw-Up Act Cd:                                           C = Please Correct and Resubmit

                                                                        P = Please Resubmit Original Transaction

INFO #:                                                            Call the telephone number displayed for more information.

 

 

RESPONSES (contd.)

VERIFONE RESPONSE                                    DESCRIPTION/COMMENTS

-----------------------------------

PLAN ELIG. & BENEFITS                               This section displays the client’s eligibility and benefit

-----------------------------------                         information. Medicare and Other insurance information

                                                                        may be displayed, separated by dashes (-----).

Plan:                                                               This field displays the name of plan.

Plan Cd:                                                         This field displays the 2-character code for other Third Party Insurance, if available.

Elig/Ben Info:                                                 This field displays the client’s level of medical coverage or other coverages, please see the ELIGIBILITY CODES section for details.

INFO #:                                                            Call the telephone number displayed for more information.

Serv Type:                                                     This field shows the service type code entered in the

                                                                        transaction.

Insr Type Cd:                                                C1 = Commercial

                                                                        MP = Medicare Primary

                                                                        MC = Medicaid

Plan Cov Desc:                                             This field will display a message for UT limits exceeded,

                                                                        client restrictions, and limitations.

Time Per Qual:                                             29 = Copay Remaining

                                                                        30 = UT exceeded

Dollar Amt:                                                    This field displays the amount of copay remaining on the client’s file.

-----------------------------------

HEALTH CARE SERVICES                             This section displays information relating to Service

-----------------------------------                         Authorization (SA) or Dispensing Validation System                                                                         (DVS) requests.

Action Cd:                                                     A1 = Certified in total

                                                                        A3 = Not Certified

                                                                        A6 = Modified

                                                                        CT = Contact Payer

                                                                        NA = No Action Required

INFO #:                                                            Call the telephone number displayed for more

                                                                        information.

Ref Id:                                                             This field displays a message or DVS number.

Modified Units:                                             This field shows the partial units that were approved

                                                                        for the Service Authorization (SA) requested.

Units: N/X/X                                                    For confirmations, this field shows the approved

                                                                        units, posted lab units, and posted Rx/OTC units.

Dental Info:                                                    This field shows the tooth, arch and quadrant for a

                                                                        Dental DVS Confirmation.

Quantity Approved:                                     This field shows the quantity that was approved for a

                                                                        DVS Confirmation.

Rej Reason Cd:                                             This field displays the Reject Reason codes.

 

ELIGIBILITY CODES

CODE                                                              ASSOCIATED COVERAGES

1 - ACTIVE COVERAGE                                 MA ELIGIBLE

                                                                        MA ELIGIBLE HR UTILIZATION THRESHOLD

B - COPAYMENT                                            COPAYMENT

E - EXCLUSIONS                                            ELIGIBLE ONLY OUTPATIENT CARE

                                                                        ELIGIBLE EXCEPT LONG-TERM CARE

F - LIMITATIONS                                           EMERGENCY SERVICES ONLY

                                                                        PRESUMPTIVE ELIGIBILITY LONG-  TERM/HOSPICE

                                                                        PRESUMPTIVE ELIGIBILITY PRENATAL A

                                                                        PRESUMPTIVE ELIGIBILITY PRENATAL B

                                                                        PERINATAL FAMILY

                                                                        ELIGIBLE ONLY FAMILY PLANNING SERVICES

                                                                        AT SERVICE LIMIT

N - SERVICES RESTRICTED TO                    SERVICES RESTRICTED TO THE

THE FOLLOWING PROVIDER                        FOLLOWING PROVIDER

R - OTHER OR ADDITIONAL PAYOR             ELIGIBLE CAPITATION GUARANTEE

                                                                       MEDICARE COINSURANCE DEDUCTIBLE ONLY

                                                                       FAMILY HEALTH PLUS

MC - MANAGED CARE COORDINATOR       ELIGIBLE PCP

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REJECT CODES

CODE                                                              POSSIBLE ERRORS

CT - CONTACT PAYER                                  CALL 1-800-343-9000

I - NON COVERED                                           NOT MA ELIGIBLE

                                                      NO COVERAGE PENDING FAMILY HEALTH PLUS

U - CONTACT FOLLOWING ENTITY              CALL 1-800-343-9000

FOR ELIGIBILITY OR BENEFIT

INFORMATION

Y - SPENDDOWN                                             NO COVERAGE: EXCESS INCOME

15 - REQUIRED APPLICATION                       NO UNITS ENTERED

DATA MISSING

33 - INPUT ERRORS                                        ITEM NOT COVERED

                                                                         MISSING/INVALID DVS QUANTITY

                                                                         CURRENT DATE REQUIRED

                                                                         COS/ITEM INVALID

                                                                         MISSING/INVALID TOOTH/QUADRANT

41 – AUTHORIZATION/ACCESS                   DOWNLOAD REQUIRED

RESTRICTIONS                                              INVALID TRAN TYPE

INVALID TERMINAL ACCESS

SERVICE NOT ORDERED

LOST/STOLEN TERMINAL

PAYMENT PAST DUE

SSN ACCESS NOT ALLOWED

42 – UNABLE TO RESPOND AT                     RESUBMIT TRANSACTION

CURRENT TIME

 

 

REJECT CODES (contd.)

CODE                                                              POSSIBLE ERRORS

43 – INVALID/MISSING PROVIDER               INVALID PROVIDER NUMBER

INFORMATION                                               REENTER ORDERING PROVIDER

                                                                        INVALID LICENSE TYPE

                                                                        DISQUALIFIED ORDERER

                                                                        DECEASED ORDERER

                                                                        INVALID ORDERING PROVIDER

                                                                        INVALID REFERRING PROVIDER NUMBER

                                                                        PRESCRIBING PROVIDER LICENSE INACTIVE

45 – INVALID/MISSING PROVIDER               INVALID TAXONOMY OR SERVICE TYPE

SPECIALTY

48 – INVALID/MISSING PROVIDER               REENTER ORDERING PROVIDER

IDENTIFICATION NUMBER                             DISQUALIFIED ORDERER

                                                                        DECEASED ORDERER

                                                                        INVALID ORDERING PROVIDER

                                                                        INVALID REFERRING PROVIDER ID NUMBER

                                                                        PRESCRIBING PROVIDER LICENSE INACTIVE

49 – PROVIDER IS NOT                                  RESTRICTED RECIPIENT NO AUTHORIZATION

PRIMARY PHYSICIAN                                    MCCP RESTRICTED RECIPIENT NO AUTHORIZATION

50 – PROVIDER INELIGIBLE FOR                  PROVIDER NOT ELIGIBLE

INQUIRIES

51 – PROVIDER NOT ON FILE                        PROVIDER NOT ON FILE

52 – SERVICE DATES NOT WITHIN               PROVIDER INELIGIBLE SERVICE ON DATE

Provider Plan Enrollment                   PERFORMED

53 – INQUIRED BENEFIT INCONSISTENT      COS NOT VALID FOR ITEM/NDC CODE

PROVIDER TYPE

60 – DATE OF BIRTH FOLLOWS                   SERVICE DATE PRIOR TO BIRTHDATE

DATE OF SERVICE

62 – DATE OF SERVICE NOT WITHIN           INVALID DATE

ALLOWABLE INQUIRY PERIOD

69 – INCONSISTENT WITH PATIENT’S         AGE EXCEEDS MAXIMUM

AGE                                                                 AGE PRECEEDS MINIMUM

70 – INCONSISTENT WITH PATIENT’S         ITEM/GENDER INVALID

GENDER

72 – INVALID/MISSING                                  INVALID CARD THIS RECIPIENT

SUBSCRIBER/INSURED ID                              INVALID ACCESS NUMBER

INVALID MEDICAID NUMBER

INVALID SEQUENCE NUMBER

75 – SUBSCRIBER/INSURED                          SOCIAL SECURITY NUMBER NOT ON FILE

NOT FOUND                                                    RECIPIENT NOT ON FILE

NO COVERAGE: PENDING FHP

NO MATCH ON FILE

84 - CERTIFICATION NOT                             DVS NOT REQUIRED

REQUIRED FOR THIS SERVICE

 

REJECT CODES (contd.)

CODE                                                              POSSIBLE ERRORS

87 – EXCEEDS PLAN MAXIMUMS                AT SERVICE LIMIT

EXCEEDS FREQUENCY LIMIT

MAXIMUM QUANTITY EXCEEDED

88 – NON-COVERED SERVICE                       PROCEDURE CODE NOT COVERED

ITEM NOT COVERED

89 – NO PRIOR APPROVAL                          NO AUTHORIZATION FOUND

91 – DUPLICATE REQUEST                           DUPLICATE – UT PREVIOUSLY APPROVED

DUPLICATE DVS

95 – PATIENT NOT ELIGIBLE                        NOT MEDICAID ELIGIBLE

FAMILY HEALTH PLUS

NO COVERAGE: PENDING FHP

NO COVERAGE: EXCESS INCOME

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ERROR RESPONSES

VERIFONE RESPONSE                                    DESCRIPTION/COMMENTS

BAD ACCESS NUMBER                                 Medicaid number (CIN) not valid.

BAD TX COMMUN                                         Bad transmission communication exists with the network.

CHECK LINE                                                   The VeriFone terminal is not plugged in or the terminal is on the same line as a telephone, which is off the hook or in use.

CONNECT 2400                                              This message is displayed until transmission to the host computer begins.

DOWNLOAD REQUIRED                                 The VeriFone software is obsolete and must be updated.

INV PRV SELECTED                                       A provider number selection was made that is not programmed into the terminal.

INV TRANS TYPE                                           An invalid transaction type other than 1-4, 6 or 7 was entered.

INVALID DATE                                               Illogical date or a date which falls outside of the                                                                         allowed inquiry period of 24 months.

INVALID RESPONSE RECEIVED                    Retry transaction.

INVALID TAXONOMY CODE                         The Taxonomy Code entered was invalid.

NO ANSWER                                                   The VeriFone is unable to connect with the network.

NO ENQ FROM HOST                                     No enquiry received from host. A problem exists with the network.

NO RESP FRM HOST                                      No response received from host. A problem exists with the network.

PLEASE TRY AGAIN                                      The card swipe was unsuccessful.

 

 

ERROR RESPONSES

VERIFONE RESPONSE                                    DESCRIPTION/COMMENTS

PROCESSING                                                 The message is displayed until the host message is                                                                         ready to be displayed.

RECEIVING                                                     This message is displayed until the host message is received by the VeriFone.

TRANSMITTING                                             This message is displayed until the host computer acknowledges the transmission.

UNREADABLE CARD                                      Will be displayed after three unsuccessful attempts to swipe the card.

WAITING FOR ANSWER                                 This message is displayed until connection is made with the network.