Vx570 Transaction Guide New Jersey Medicaid Eligibility

Transcription

1 Healthcare Point-of-Service Transactions VeriFone Vx570 Terminals Vx570 Transaction Guide New Jersey Medicaid Eligibility Version March 1, 2013 Overview This transaction allows you to verify a patient s eligibility status and benefits for New Jersey Medicaid for a span of service dates. Date of Service Restrictions Up to 24 months in the past. Future dates of service up to the end of the current month. The beginning and ending dates of service can be up to three months apart. Special Considerations Only hospital providers are allowed to use name/date of birth and Social Security number/name searches. An error is returned if a non-hospital provider attempts these search types. If you are a hospital provider and do not see these search types, call Emdeon Customer Support. To Enter Letters 1. Press the number key on which the letter appears. 2. Press <ALPHA> once, twice, or three times, until the letter appears. 3. If needed, press to delete the last character entered. 4. Special characters are on the * and # keys. Q, Z, and the decimal point (.) are on key 1. Other Usage Tips To display help information, press <F1>. If your terminal has been idle, you may be prompted to enter your user ID and password. You can assign shortcut keys (hot keys) to frequently-used payers. When you press a shortcut key from the idle prompt, your terminal will display the Transaction Type menu for the payer assigned to that key. To skip an optional prompt, press. For instructions on setting up a list of provider IDs, see your Verifone Vx570 User Guide. To display a list of entries for a prompt (e.g., provider IDs), press <F2>. Select your entry, then press. For more information, see your Verifone Vx570 User Guide. Request 1 2 WELCOME TO EMDEON SWIPE CARD OR PRESS ANY KEY MEDICAL ADDRESS VERIFY FINANCIAL SETUP LEARN MORE press any key. press <F2> for Medical (go to step 3) or press an assigned shortcut key to start the payer program (go to step 4). 3 SELECT PAYER: select NEW JERSEY. Page 1 of 5

2 4 SELECT SEARCH TYPE: ID Card #/DOB Recipient ID Social Security/Date of Birth Social SecurityName Name/Date of Birth ID Card # -- date of birth search: Choose search: ID Card #/DOB. Go to step 5. Recipient ID. Go to step 13. Social Security/Date of Birth. Go to step 20. Social Security/Name. Go to step 28. Name/Date of Birth. Go to step Provider ID inquiring provider ID. 6 Prov Last/Org 7 Prov First 8 ID Card # 9 Begin DOS 10 End DOS recipient ID or swipe card (the patient s recipient ID displays) press. 11 Date of Birth date of birth (mmddyyyy). 12 Service Type Recipient ID search: 14 Prov Last/Org 15 Prov First 16 Recipient ID 17 Begin DOS 18 End DOS 19 Service Type Social Security date of birth search: recipient ID or swipe card (the patient s recipient ID displays) press. 20 Provider ID inquiring provider ID. (Press <F2> for 21 Prov Last/Org 22 Prov First 23 Begin DOS 24 End DOS 25 Social Security Social Security number, no dashes. 26 Date of Birth date of birth (mmddyyyy). 13 Provider ID inquiring provider ID. Page 2 of 5

3 27 Service Type Social Security name search (hospital providers only): 28 Provider ID inquiring provider ID. (Press <F2> for 29 Prov Last/Org 30 Prov First 31 Begin DOS 32 End DOS 33 Social Security Social Security number, no dashes. 34 Last Name last name. 35 First Name first name. 36 MI middle initial or just to 37 Service Type Name date of birth search (hospital providers only): 38 Provider ID inquiring provider ID. (Press <F2> for 39 Prov Last/Org 40 Prov First 41 Begin DOS 42 End DOS 43 Date of Birth date of birth (mmddyyyy). 44 Last Name last name. 45 First Name first name. 46 MI middle initial or just to 47 Service Type Card Swipe (configured for idle swipe) 1 WELCOME TO EMDEON SWIPE CARD OR PRESS ANY KEY or MEDICAL ADDRESS VERIFY FINANCIAL SETUP LEARN MORE swipe card. 2 Provider ID inquiring provider ID. 3 Prov Last/Org 4 Prov First if the provider is an organization. 5 ID Card # recipient ID or swipe card (the patient s Page 3 of 5

4 6 Begin DOS 7 End DOS recipient ID displays) press. 8 Date of Birth date of birth (mmddyyyy). 9 Service Type Response Type 30 Health Benefit Plan Coverage. The following section describes each section of information that your payer can return. Individual responses can vary in content. For a detailed dictionary of response data, see the POS v4 Standard Eligibility Response Dictionary. To reprint the last response, press <Scroll Line >. Input Information The information you entered in your request. New Jersey Medicaid Information Basic information about the transaction, such as: The Submit ID used for tracking Benefit Indicator: Y = Benefit information exists N = No benefit information exists P = Pending Q = QMB S = Spenddown Medicare Indicator: A = Patient has Medicare Part A coverage B = Patient has Medicare Part B coverage A&B = Patient has Medicare Parts A and B coverage NA = Unable to determine Medicare coverage Y = Medicare information is present Other Payer Indicator: Y = Patient has other payer coverage NA = Unable to determine other payer coverage Information Source Information about the payer, such as primary ID and name. Information Receiver Information about the requesting provider, such as primary ID and name. Subscriber Information about the subscriber. Includes: The transaction audit (trace) numbers and origins The subscriber s primary ID Demographic information, such as name, date of birth, gender; returned when the subscriber is the patient Subscriber identification numbers other than the primary ID Eligibility or benefit dates. Dates can also appear in the Eligibility/Benefit section Eligibility or Benefit Details The eligibility and benefit sections give details about the patient s eligibility status and other types of benefits. There can be several eligibility and benefit sections. Each section header describes the eligibility status or benefit type to which the section applies. Your response can include the following sections: Actv Cvg (Active Coverage) Inactv (Inactive) Svces Restricted to Following (Services Restricted to Following Provider) Note: A row of all dashes designates the beginning of another section of data of the same eligibility/benefit type as the preceding section. Information for each type of eligibility status or benefit section can include: Coverage type. Service types 1. Your response can include the following: Health Bene Plan Cvg (Health Benefit Plan Coverage) Pharm (Pharmacy) Applicable dollar amount or percentage Page 4 of 5

5 Insurance type 2. Your response can include the following: HMO (Health Maintenance Organization) Indiv Pol (Individual Policy) Mcare A (Medicare Part A) Mcare B (Medicare Part B) Mcaid (Medicaid) Other Plan coverage information Benefit period Benefit quantity Authorization or certification required In-network indicator Product or service ID Procedure Modifiers Additional identifiers Benefit-specific eligibility dates Limitations Information used to determine eligibility Benefit-related entity and entity contact information 1 see Service Types (HIPAA) 2 see Insurance Types (HIPAA) Error Messages Transaction-related error messages begin with CL, HT, or RH, followed by a number and a line or so of text. Most messages are self-explanatory. The following message is of particular interest for this transaction: For a comprehensive description of all error messages, see the document Dictionary of Transaction Error Messages. Page 5 of 5