MEDICAID IDENTIFICATION NUMBERS


PERMANENT 13-DIGIT IDENTIFICATION NUMBER

In the past, the Medicaid recipient identification number assigned to recipients was a 13- digit number that included as a part of the number a two-digit parish code as the first and second digits of the number, and a two-digit eligibility category code as the third and fourth digits of the number. Additionally, the 12th and 13th digits represented the household member.  The use of an “intelligent” number that houses pieces of information in this manner has caused billing difficulty for the provider community.  Whenever a recipient moves or changes category of eligibility, a new number is issued.  Thus, providers are continually changing numbers for their recipient patients.  In spite of the best efforts by DHH to systematically link multiple ID numbers to a single recipient, problems have been experienced.  Many claims have denied for name, number, or eligibility issues, and the provider has had the burden of locating another identification number with which to re-bill claims.

In an effort to resolve these issues, beginning July 6, 1999, a permanent 13-digit person number was assigned to each Medicaid recipient.  For each individual on the Molina Medicaid Solutions recipient file on June 30, 1999, the most current 13-digit recipient identification number was frozen and became the permanent Medicaid recipient identification number.  Providers should remember, however, that although the numbers may “look” the same, the numbers will not denote any pieces of information as in the past. 

Examples of this are as follows: 1)  “1” and “7” in the third and fourth digits of the Medicaid ID number no longer necessarily indicate the recipient is a pure QMB; 2)  “1” and “6” in the third and fourth digits no longer necessarily indicate the recipient is presumptive eligible; 3)  “0” and “2” in the first and second digits no longer necessarily indicate the recipient is currently certified in Allen parish; and 4) “0” and “1” in the 12th and 13th digits no longer necessarily indicate the recipient is the first dependent within a certified family.

Recipients added to the file as of July 1, 1999 and after have been assigned a new, permanent 13-digit number.  These newly assigned 13-digit numbers may look somewhat unusual to you (i.e., 0000000000001, 8888888888888, 0000000000025, 0000000486100, 0000761147692).

USE OF PREVIOUSLY ISSUED RECIPIENT IDENTIFICATION NUMBERS

This does not mean that other identification numbers previously issued to recipients may not be used to bill claims for services rendered.  Any 13-digit number that was a valid recipient number and is still on the recipient file may be used to bill claims.  In fact, in situations where services were pre-certified or prior authorized using a certain number other than the new, permanent 13-digit person number, it will be necessary to bill using the number under which the pre-certification or prior authorization was issued.  

Beginning in July 1999, providers should make note of the identification number confirmed or obtained from Molina REVS or MEVS eligibility inquiries, as this number will be the PERMANENT number.  For dates of service and pre-certification and prior authorization after July 1, 1999, the permanently assigned 13-digit person number will be used by all DHH and Molina systems.

PARISH AND ELIGIBILITY INFORMATION

Information previously obtained from the “intelligent” number is currently and will continue to be supplied as a part of the response given when making eligibility inquiries through MEVS or REVS.  Although the parish name or number will not be provided, the response message returned to the provider will supply all information required to service the recipient.  The following table is representative of the types of information received from MEVS or REVS:

Recipient Eligibility Response
Recipient resides in a Community Care parish and is Community Care recipient   Message indicates that the recipient is Community Care and includes the name of the recipient’s PCP and the telephone number of the PCP to allow the inquiring provider to contact the PCP for a referral prior to providing services.  
Recipient is eligible through a category of service that limits coverage of certain services or by certain providers

Information provided as part of eligibility response.

For example:  If the recipient is covered through the Medically Needy Program, which does not cover certain services, and the provider calling is a provider of a non-covered service, the response will include a message indicating that the recipient is Medically Needy and the services provided by the calling provider would not be covered.

Recipient is QMB eligible

Message indicates QMB eligibility.  In cases where the recipient is Pure QMB, the response will state:

“This recipient is only eligible for Medicaid payment of deductible and co-insurance of services covered by Medicare.  This recipient is not eligible for other types of Medicaid assistance.”  

Recipient is presumptively eligible Response will indicate: “This recipient may be eligible for outpatient ambulatory services only.  Providers must call 1-800-834-3333 to verify current eligibility.”  
Recipient is a child Message indicates that the recipient is EPSDT eligible, meaning the recipient is under 21 years of age and eligible for all services and service limits allowed for children.

All eligibility and service limit information is related to the inquiring provider in this same manner. However, the provider still must know and understand policy limitations.

This will provide the eligibility information formerly provided by the 13-digit recipient number and the paper cards that were replaced by permanent, plastic identification cards.