Medicaid Eligibility Verification (MEV)

Before a Financial Eligibility can be saved in Closed Complete status, a Medicaid Eligibility Verification (MEV) must be completed and submitted to Texas Medicaid and Healthcare Partnership (TMHP).

 

How to create and submit a Medicaid Eligibility Verification (MEV)

Once the Financial Eligibility has been saved in Ready for Review, a Request Medicaid Eligibility Verification button is displayed in the Third Party Resource Information section.

Below the button is the Medicaid Eligibility Verification Status information box which shows the status and the status date. The initial status is Electronic Verification Not Requested.

Select the Request Medicaid Eligibility Verification button and the Medicaid Eligibility Verification Request window will display.

The Provider NPI/API number populates from the Provider Location detail. Please contact your agency’s local security administrator for more information on your agency’s identifiers.

The Eligibility From Date and Eligibility Through Date will default to a date range that ends on the last day of the current month, and begins 90 days in the past. These fields can be changed to cover service days, if necessary.

The Client Information Fields on the page are pre-populated from either the Client Profile or the Financial Eligibility pages for the active client.

In order to perform a Medicaid Eligibility Verification Request, one of the following valid field combinations is required:

• Medicaid ID and Date of Birth or
• Medicaid ID and Last Name or
• Medicaid ID and Social Security Number or
• Social Security Number and Last Name or
• Social Security Number and Date of Birth or
• Date of Birth and Last Name and First Name

“If space has been removed from the client’s First name/Last Name, please insert a space before submitting MEV Request.”  The client’s name in the TMHP database will have spaces, the CMBHS database does not. If your client has two first names or two last names, insert a space between the names before submitting the MEV.

 

 

Client Information to be Submitted to Medicaid Payer Section

Medicaid ID field – populated from the Client Profile, if available at the time of MEV submission.

Last Name – Client’s Last Name from the Client Profile.

First Name – Client's First Name from the Client Profile.

Middle Name – Client’s middle name from the Client Profile, if available.

Social Security Number – Client’s social security number from the Client Profile.

Date of Birth – Client’s Date of Birth from the Client Profile.

Once this is completed, select the Submit button. If you decide not to submit the MEV, the Close button will close the MEV window.

The following statement is located at the bottom of the page:

Sending a Medicaid Eligibility Verification Request may result in updates to the client's CMBHS Client Profile and Financial Eligibility. When the Medicaid Eligibility Verification results return, a Medicaid Eligibility Verification Results page will be added to the Client Workspace Document List.

 

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Reviewing the results of a submitted MEV

Once the MEV has been submitted and has interfaced with TMHP, a result will be returned with notification and documentation on:

• The client’s Client Workspace – an MEV Document will be displayed with the results returned from TMHP.
• The client’s Financial Eligibility – the Third Party Resource Information section will be updated to state the status of the MEV.
• The Medicaid Eligibility Verification List Screen – found under the Business Office tab on the Administrative Toolbar, this screen lists all MEVs that have been submitted to TMHP.
• The client’s Client Profile – if the client has Medicaid, the Medicaid Identifier will be updated to include the Medicaid number and the new end date, which is the last day of the current month.

Once the MEV has been processed, the user must return to the Financial Eligibility document to change its status to Closed Complete.

NOTE: Only a status of Closed Complete on the Financial Eligibility document will allow claims to be submitted.

• Print the document and have the client sign it. Keep the paper documents in a file.
• After the client has signed, change the Document Status to Closed Complete and CLICK Save.

 

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Creating a Medicaid Eligibility Verification Separately from the Financial Eligibility

The Medicaid Eligibility Verification can be submitted to TMHP separately from creating a Financial Eligibility by using the MEV Request form from the Intake menu. This method can obtain a client’s Medicaid status without connection to the Financial Eligibility document.

From the left Client Services Toolbar, select Intake > Medicaid Eligibility Verification. The Medicaid Eligibility Verification Request form displays in edit mode in a separate window.

The Provider NPI/API number populates from the Provider Location detail. Please contact your agency’s local Security Administrator for more information on your agency’s identifiers.

The Eligibility From Date and Eligibility Through Date will default to a date range that ends on the last day of the current month, and starts 90 days in the past. These fields can be changed to cover service days, if necessary.

The Client Information Fields on the page are pre-populated from either the Client Profile or the Financial Eligibility pages for the active client.

In order to perform a Medicaid Eligibility Verification Request, one of the following valid field combinations is required:

• Medicaid ID and Date of Birth or
• Medicaid ID and Last Name or
• Medicaid ID and Social Security Number or
• Social Security Number and Last Name or
• Social Security Number and Date of Birth or
• Date of Birth and Last Name and First Name

If space has been removed from the clients First name/Last Name, please insert it before submitting the MEV Request. The client’s name in the TMHP database will have spaces, but the CMBHS database does not. If your client has two first names or two last names, insert a space between the names before submitting the MEV.

 

Client Information to be Submitted to Medicaid Payer Section

Medicaid ID field – populated from the client profile, if available at the time of submitting the MEV.

Last Name – Client’s Last Name from the Client Profile.

First Name – Client First Name from the Client Profile.

Middle Name – Client’s middle name from the Client Profile, if available.

Social Security Number – Client’s social security number from the Client Profile.

Date of Birth – Client’s Date of Birth from the Client Profile.

Once completed select the Submit button. If it is decided not to submit the MEV, the Close button will close the MEV window.

 

The following statement is located at the bottom of the page:

Sending a Medicaid Eligibility Verification Request may result in updates to the client's CMBHS Client Profile and Financial Eligibility. When the Medicaid Eligibility Verification results return, a Medicaid Eligibility Verification Results page will be added to the Client Workspace Document List.