New York State Medicaid Update - February 2021 Volume 37 - Number 2

In this issue …

Medicaid Eligibility Verification System and Dispensing Validation System Provider Manual

The Medicaid Eligibility Verification System (MEVS) and Dispensing Validation System (DVS) enable a provider to verify member eligibility prior to the provision of services and obtain authorization(s) for specific services covered under DVS. A member, also known as a client, recipient, or enrollee, must present an official Common Benefit Identification Card (CBIC) to the provider when requesting services. As the issuance of a CBIC does not constitute full authorization for provision of medical services and supplies, the member eligibility must also be verified through eMedNY to confirm the member's subsequent eligibility for services and supplies. A provider that does not verify eligibility prior to provision of services will risk nonpayment for those services. A provider uses the following methods to access the verification process through eMedNY:

  • Telephone verification method: Audio Response Unit (ARU)
  • Other access methods:
    • Electronic Provider Assisted Claim Entry System (ePACES)
    • Central Processing Unit (CPU): CPU-to-CPU link
    • eMedNY eXchange
    • File Transfer Service using Simple Object Access Protocol (SOAP)
    • CORE (Committee on Operating Rules for Information Exchange compliant) Web Services

Information regarding MEVS access methods and links to those listed above can be found within eMedNY's New York State Medicaid: Medicaid Eligibility Verification System (MEVS) Methods document.

MEVS/DVS Provider Manual

The MEVS/DVS Provider Manual is a valuable resource to assist providers in interpreting the MEVS message providers encounter when checking eligibility. It is also an introductory guide for:

  • Information about CBICs and/or forms
  • The Telephone ARU Verification method
  • Important Reference tables:
    • Eligibility Benefit Descriptions
    • Reject Reason Codes
    • Decision Reason Codes
    • Exception Codes
    • County/District Codes
    • New York City Office Codes

Additional Information and Questions:

  • For questions regarding Medicaid eligibility training and/or other ePACES training related functions, visit eMedNY's Provider Training page.
  • All provider questions regarding messages received, must be directed to the eMedNY Call Center at (800) 343‑9000.

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Help Stop the Spread of COVID-19 by Sharing the COVID Alert NY App

New York State Department of Health's COVID Alert NY app is gaining participation with more New Yorkers every day. Please keep sharing the COVID Alert NY app information with partners and consumers. Together everyone can help stop the spread of this virus.

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Medicaid Consumer Fact Sheets Now Available

New York State Department of Health (DOH) Office of Health Insurance Programs (OHIP) has created Medicaid consumer fact sheets focused on chronic health conditions. Each fact sheet provides information regarding how a condition can be prevented and managed, as well as relevant Medicaid benefits that can be used to help enrollees stay healthy. Topics include diabetes, high blood pressure, asthma control, and HIV-PrEP (Human Immunodeficiency Virus - Pre-Exposure Prophylaxis).

Fact sheets can be found on the Medicaid Redesign Team (MRT) II Policies and Guidance web page, available in the following languages: English, Spanish, Traditional Chinese, Russian, Haitian Creole, Bengali and Korean.

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Reminder: Sign Up for eMedNY Training Webinars

eMedNY offers several training webinars to providers and their billing staff. Webinars are conducted online, so that providers may join the meeting via a computer and telephone.

Valuable provider webinars offered include:

  • ePACES for Dental, Durable Medical Equipment (DME), Free-Standing and Hospital-Based Clinics, Home Health, Institutional, Nursing Home, Physician, Private Duty Nursing, Professional (Real-Time), Transportation and Vision Care
  • ePACES for Dispensing Validation System (DVS) for DME
  • ePACES for DVS for Rehabilitation Services
  • eMedNY Website Review
  • Medicaid Eligibility Verification System (MEVS)
  • New Provider / New Biller

Webinar registration is fast and easy. To register and view the list of topics, descriptions and available session dates, please visit the Provider Training web page. Providers are reminded to review the webinar(s) descriptions carefully to identify the webinar appropriate for their specific training needs.

Questions regarding training webinars should be directed to the eMedNY Call Center at (800) 343‑9000.

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NY State of Health Open Enrollment Deadline Extended Through May 15

There is still time for consumers to enroll in 2021 health coverage. Governor Cuomo recently announced that the NY State of Health Open Enrollment Period for Qualified Health Plans has been extended through May 15, 2021, aligning with states across the country. With this extension, New York joins the federal Marketplace, along with other state-based Marketplaces, in giving consumers even more time to enroll for 2021 as the battle against COVID-19 continues and the vaccination program rolls out. The HHS Announces Marketplace Special Enrollment Period for COVID-19 Public Health Emergency press release is now available.

Enrollment remains open for all NY State of Health programs, which is especially important during the public health emergency. As always, consumers can apply for coverage through the NY State of Health website, by phone at (855) 355‑5777, or by connecting with a free enrollment assistor via NY State of Health's "Find Broker/Navigator" search tool. Coverage deadlines and start dates are:

  • Enroll by March 15: Coverage starts April 1
  • Enroll by April 15: Coverage starts May 1
  • Enroll by May 15: Coverage starts June 1

Additional information on NY State of Health insurance options during the COVID-19 emergency can be found at the NY State of Health Coronavirus (COVID-19) Information web page.

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The Medicaid Update is a monthly publication of the New York State Department of Health.

Andrew M. Cuomo
Governor
State of New York

Howard A. Zucker, M.D., J.D.
Commissioner
New York State Department of Health

Donna Frescatore
Medicaid Director
Office of Health Insurance Programs