Page 15

BAM 402 15 of 20 MA BENEFITS BPB 2021-026 10-1-2021

BRIDGES ADMINISTRATIVE MANUAL STATE OF MICHIGAN DEPARTMENT OF HEALTH & HUMAN SERVICES

PROVIDER INQUIRIES

Eligibility Verification System (EVS) MA Beneficiary information is available to medical/dental providers through an automated system called the Eligibility Verification System (EVS). If the beneficiary is eligible, the following information is available: • Beneficiary name, beneficiary ID number, gender, date of birth. • Benefit plan ID(s) for the date of service (DOS). • PET code information, source provider ID, National Provider Identifier(NPI), provider name, telephone number, address, and the patient pay amount, if applicable. • Medicaid health plan, primary care physician, including the provider name and telephone number. • Third party liability, including the payer name, payer ID, coverage type code, group number, policy number, and policyholder ID. • Pending Medicaid eligibility. Additional information is not available through EVS. CHAMPS Providers may verify beneficiary eligibility using: • CHAMPS Eligibility Inquiry. • HIPAA 270/271 (eligibility inquiry/response) transactions. Refer to the Michigan Medicaid Provider Manual, Beneficiary Eligibility and Directory Appendix Sections for further information. Providers may contact the MDHHS Provider Inquiry Helpline at 1- 800-292-2550 for questions/issues related to the eligibility response.

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Page 15

Official source

BAM 402 15 of 20 MA BENEFITS BPB 2021-026 10-1-2021

BRIDGES ADMINISTRATIVE MANUAL STATE OF MICHIGAN DEPARTMENT OF HEALTH & HUMAN SERVICES

PROVIDER INQUIRIES

Eligibility Verification System (EVS) MA Beneficiary information is available to medical/dental providers through an automated system called the Eligibility Verification System (EVS). If the beneficiary is eligible, the following information is available: • Beneficiary name, beneficiary ID number, gender, date of birth. • Benefit plan ID(s) for the date of service (DOS). • PET code information, source provider ID, National Provider Identifier(NPI), provider name, telephone number, address, and the patient pay amount, if applicable. • Medicaid health plan, primary care physician, including the provider name and telephone number. • Third party liability, including the payer name, payer ID, coverage type code, group number, policy number, and policyholder ID. • Pending Medicaid eligibility. Additional information is not available through EVS. CHAMPS Providers may verify beneficiary eligibility using: • CHAMPS Eligibility Inquiry. • HIPAA 270/271 (eligibility inquiry/response) transactions. Refer to the Michigan Medicaid Provider Manual, Beneficiary Eligibility and Directory Appendix Sections for further information. Providers may contact the MDHHS Provider Inquiry Helpline at 1- 800-292-2550 for questions/issues related to the eligibility response.