Checking a Medicaid Recipient's Eligibility
Approximately 225,000 Medicaid claims deny each month because the Medicaid recipient is not eligible. Providers should check eligibility by:
- Calling DMS' Interactive Voice Response System (1-800-392-0938)
- Through the internet at: www.emomed.com or
- through a Point of Service Terminal.
Reasons to check eligibility are:
- To determine the person's name as it appears on the enrollment file. The claim must be filed with the person's current file name.
- To check to see if the person is eligible on the date of service.
- The determine the person's medical eligibility (ME) code. Codes 55, 58, 59 and 80 have limited benefits. Codes 74, 75, 76 and 79 require a co-payment.
- To see if a person is Medicare eligible. The claim must be filed to Medicare first.
- The see if the person has commercial insurance in addition to Medicaid. The claim must be filed to commercial insurance first.
- To see if the person is enrolled in a MC+ managed health care plan. If so the claims must be submitted to the appropriate MC+ managed health care plan.
- To determine if the person is locked in to another provider(s). If so the person must receive services from that provider unless a lock-in referral (PI - 118) is submitted from the lock - in provider.