Medicaid on the Web Eligibility Verification

Medicaid on the Web Eligibility Verification

Each site will be assigned a “generic” id in order to access the website. The OHCA web page is:

Eligibility will need to be run on all 23 admits, 21 contacts, and 41 fee updates.

Log in using your assigned userid and password. If there are messages click next at the bottom of the page. In the green task bar at the top of the page you will see Eligibility. Click on this icon to check the Eligibility. There are several ways to verify.

(1)ClientId (T19 number)

(2)SSN and Birthdate

(3)Name and DOB

(4)Case Number

Enter the current month dates to ensure you have the latest dates the client has T19. Print the verification sheet. **Please note: The EFC chart# will not appear on the print out. Please write the EFC chart # on the verification sheet. Attach the verification sheet to the client agreement form.

On the bottom of the sheet the print out will state whether the client has T19 for the time frame you entered. This is “realtime” data. What this means is you are accessing the OHCA database for your inquiry. Other information the sheet may give you is if the client has Medicare part A or B or both, and Private Insurance.

If the client has Medicare or Private Insurance it must be noted on the client agreement form. If the client has Medicare data processing will need a Medicare number in order to file the claim. Medicare only pays for doctor visits. If you find the client has Private Insurance please note Data Processing will need the name of person providing the insurance. In most cases it is not the client thus it will be a parent or stepparent etc. We must have the insured’s name, SSN number and group number from the insurance in order to bill the service.

Important!!

T19 will not pay for any services if a client has Medicare or Private Insurance if the other pay source will pay on the claim. Data Processing will submit the claim to the Insurance Company. If the claim is denied because the deductible has not been met then the service must be written off to EFC charity and “CANNOT” be billed to T19. If the service is denied because the Insurance has lapsed or the client does not have mental health benefits under the Insurance plan, then Data Processing can submit this denial to T19, they will review it, and make a decision if they will pay for the service.