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
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 Gainwell Technologies 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).
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 Gainwell Technologies 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 Gainwell Technologies
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:
resides in a Community Care parish and is Community Care recipient
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
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
indicates QMB eligibility. In
cases where the recipient is Pure QMB, the response will state:
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."
is presumptively eligible
will indicate: "This
recipient may be eligible for outpatient ambulatory services only.
Providers must call 1-800-834-3333 to verify current
is a child
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
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.
will provide the eligibility information formerly provided by the 13-digit
recipient number and the paper cards that were replaced by permanent, plastic