Automated Voice Response (AVR) 
User Guide





 



April 2009





About This Guide
The Massachusetts Eligibility Verification System (EVS) and its subsystems, including the 
Automated Voice Response (AVR) system, are applications available to providers participating in 
MassHealth. This information system complies with the federal Health Insurance Portability and 
Accountability Act (HIPAA). The system provides the most current information from MassHealth, 
24 hours a day, 7 days a week.
This manual provides instructions for accessing EVS by using AVR at 1-800-554-0042.
Important Contact Information for EVS
For further information about EVS access methods or if you have other questions, contact 
MassHealth Customer Service at 1-800-841-2900, or e-mail your inquiries to 
providersupport@mahealth.net.


Table of Contents
Automated Voice Response (AVR) System	1
Accessing AVR	1
Important Reasons to Access EVS Before Providing Services	1
General Information about Using EVS	2
Trading Partner Agreements	2
HIPAA Compliance	2
Security and Privacy	2
User Name and Password	2
Changing Your Password	3
Automated Voice Response (AVR) Flow Chart	4
Telephone Specifications	5
Special Function Keys	5
Using AVR	5
Eligibility Verification	6
Verifying Eligibility by Member ID	6
Verifying Eligibility by the Member’s Social Security Number (SSN) or Other Agency ID	7
Verifying Eligibility by the Member’s Last Name, First Initial, Date of Birth, and Gender	7
AVR Messages	8
Verification Messages	8
Call Termination Messages	11
Error Messages	12
Alphabetic Character-to-Number Conversion for AVR	14
Contact Information	16
Glossary	17



Automated Voice Response (AVR) System
Providers can access EVS data through the Automated Voice Response (AVR) system by calling 1-800-
554-0042.
The automated voice response system allows you to verify eligibility by member ID, by social security 
number or other agency ID, or by the member’s name, gender, and date of birth. It is recommended to 
use AVR only when you do not have access to the Provider Online Service Center (POSC) or the EVSpc 
software at your facility or when your primary way to access EVS is not functioning properly.
You must have a valid user name and password appropriately associated with a MassHealth provider or 
National Provider Identifier (NPI) number in order to access AVR. For further information, contact 
MassHealth Customer Service at 1-800-841-2900, or e-mail your inquiry to 
providersupport@mahealth.net.
Accessing AVR
MassHealth maintains a Web site that has useful information for MassHealth providers. The Web site, 
www.mass.gov/masshealth, includes current provider manuals, recent provider bulletins, links to useful 
documents, regulations, and other information. There is also a section that contains information about 
the Eligibility Verification System (EVS). Within this section you will find details about Automated 
Voice Response (AVR).
Important Reasons to Access EVS Before Providing Services
*	EVS verifies if the MassHealth member is eligible for services, and provides benefit plan and 
additional coverage information.
*	EVS identifies the current primary care clinician for each individual MassHealth member 
enrolled as a member of the Primary Care Clinician (PCC) Plan.
*	EVS identifies the current managed care organization provider for each individual MassHealth 
member enrolled as a member of the MCO plan.
*	EVS reduces the risk of your claim being denied.
*	EVS simplifies the identification of a member’s MassHealth Enrollment Center/local office for 
purposes of resolving any questions on eligibility time frames.
*	EVS identifies any third-party-liability information to ensure proper billing.
*	EVS aids in providing timely health-care services for all members.


General Information about Using EVS
Trading Partner Agreements
To access EVS, the provider must first have submitted a signed Trading Partner Agreement (TPA). The 
primary contact for Health Insurance Portability and Accountability Act (HIPAA) at your organization 
should be able to give you more information on whether you have a signed TPA on file. The TPA and 
other related information are available on the MassHealth Web site at www.mass.gov/masshealth.
HIPAA Compliance
EVS meets the ANSI ASC X12N 270/271 health-care eligibility benefit inquiry and response standards. 
Data transmissions to and from these systems meet the security standards of the HIPAA security 
regulations.
Associated companion guides for HIPAA 270/271 transactions can be found at 
www.mass.gov/masshealth.
Security and Privacy
Your current MassHealth provider agreement in combination with the TPA requires you to make every 
effort to secure and protect information transmitted to and received from our system.
To access EVS you must also have a valid user name and password. To determine if you have a valid 
user name and password, call MassHealth Customer Service at 1-800-841-2900, after submitting the 
signed TPA.
User Name and Password
Each provider receives one primary user name and password per provider number. You must then 
determine if additional users are needed to support your activities for MassHealth. You must protect 
your password securely.
*	Do not write your password in an easily accessible place.
*	Do not share your password with anyone.
*	Choose a password that is not easy to guess.
*	The password must be alphanumeric (letters and numbers only).
*	The user name and password are case sensitive.
*	The user name must contain one uppercase letter, one lowercase letter, and one number.
*	The password must be a minimum of eight characters, with a maximum of 16 characters.



The following table lists a few password examples. 

Valid Passwords
Invalid Passwords
Comments
WebEVS24
WebEVSab
Must include a number.
JOHN03aa
JOHN03AA
Must include a lowercase letter.
Reporter1
reporter1
Must include an uppercase letter.
Johnny03
Johnny3
Must be at least eight characters long.
Changing Your Password
You can change your password by accessing EVS at www.mass.gov/masshealth. If this Web site is 
unavailable, contact MassHealth Customer Service at 1-800-841-2900 for assistance.



Automated Voice Response (AVR) Flow Chart
 


Telephone Specifications
The only type of telephone that can be used to access EVS is a regular touch-tone phone. It can be 
identified by different tones when dialing.
Note: The primary method of performing eligibility inquiries should be by using the EVSpc software, 
because AVR returns limited information and the connection can be lost if you take too long to 
respond to a prompt.
Special Function Keys
There are three keys on the telephone keypad that have different functions. The following is an 
explanation of their functions. 

Key
Description
#
The pound sign. To proceed to the next step, press this key 
after entering each piece of information.
8
The number 8 key. For assistance or for questions about the 
use of the MassHealth Automated Voice Response System, 
press this key.
9
The number 9 key. To repeat the previous message, press 
this key.
Using AVR
The following are step-by-step instructions for using AVR to verify MassHealth eligibility.
1.	Dial 1-800-554-0042. You will hear the following message.
Welcome to MassHealth. If you are a MassHealth provider, press 1. If you are a MassHealth cardholder, 
press 2. To repeat this information, press 9.
OR
The Eligibility Verification System is currently unavailable. Please contact MassHealth Customer Service 
at 1-800-841-2900 for assistance. Thank you.
Note: If the system supporting MassHealth is unavailable, AVR responds with the message 
above. However, access may still be available through the EVSpc software. If you have 
difficulty accessing the system, call MassHealth Customer Service at 1-800-841-2900.
2.	Press option 1 for provider services. Enter your user name for the NPI/provider number you need 
to verify. Pay close attention to entering the correct case for each letter. Enter your user name 
followed by the pound sign. To enter a number, simply press that number. To hear information 
on how to enter an uppercase or lowercase letter, press 1 followed by the pound sign. 


If you press 1 and the pound sign, you will hear the following message.
To enter alphabetic characters press the asterisk or star sign followed by a two-digit numeric code. The 
first digit of the numeric code corresponds to the key number on which the character appears. The 
second digit of the numeric code corresponds to the position of the letter on the key and whether it is 
upper or lowercase. To enter an uppercase letter, the second digit will use either the 1, 2, or 3 key. To 
enter a lowercase letter, the second digit will use the 4, 5, or 6 key. For example the code *21 is used to 
enter the uppercase letter 'A'. The code *24 is used to enter the lowercase letter 'a'. To enter uppercase 
'Q' use *11 and for lowercase 'q' use *14. To enter uppercase 'Z' use *12 and for lowercase 'z' use *15.
3.	Confirm your response.
You have selected [AVR repeats the letters you entered, but will not include the case]. Press 1 to confirm 
this selection. Press 2 to change your selection.
4.	Enter the password associated with your user name. Enter your password followed by the pound 
sign. To enter a number, simply press that number. To hear information on how to enter an 
uppercase or lowercase letter, press 1 followed by the pound sign.
If you press 1 and the pound sign, you will hear the same message as in Step 2. After you make the 
entry you will hear the following message.
You have selected [AVR repeats the letters you entered, but will not include the case]. Press 1 to confirm 
this selection. Press 2 to change your selection.
5.	Enter your NPI or provider number associated with the user name. 
Enter your NPI or provider number followed by the pound sign. If you enter a nine-character 
provider number, you will hear the following message.
Please enter your one-character location code followed by the pound sign.
Follow the instructions in Step 2 to enter an alpha character.
6.	Next you will hear the main menu.
Press 1 to verify eligibility by member ID. Press 2 to verify eligibility by social security or other agency ID. 
Press 3 to verify eligibility by name. Press 4 to change your password. To end this call, hang up. For 
assistance, press 8. To repeat this information, press 9.
Eligibility Verification
Eligibility of a MassHealth member can be done by using any of the following.
*	Member ID
*	Social security number (SSN) or other agency ID
*	Member’s last name, first name, date of birth, and gender
Verifying Eligibility by Member ID
After following steps 1-6 above, follow steps 7-9 below to verify a MassHealth member’s eligibility 
using the member ID.
7.	Press 1 to verify eligibility by member ID. This is the prompt you will hear for entering the 
member’s ID.
Enter the member ID followed by the pound sign.




8.	Enter the member’s 12-digit ID followed by the pound sign.
Enter the date of service in MMDDYYYY format, followed by the pound sign. For today press the pound 
sign.
9.	Enter the date of service that you are checking followed by the pound sign. For instance, January 
4, 2004, would be entered as 01042004#. If you are using the current day as the date of service, 
press the pound sign.
Your response will be returned momentarily. The response information begins on page 8.
Verifying Eligibility by the Member’s Social Security Number (SSN) or Other Agency ID
After following steps 1-6 above, follow steps 7-9 below to verify a MassHealth member’s eligibility 
using the SSN or other agency ID.
7.	Press 2 to verify eligibility by member’s SSN or other agency ID. Enter social security number or 
other agency ID, followed by the pound sign.
8.	Enter the member’s nine-character SSN or agency ID followed by the pound sign. For ‘X’ enter *92, 
for ‘Y’ enter *93, and for ‘Z’ enter *12. The next prompt you will hear is for entering the date of 
service.
Enter the date of service in MMDDYYYY format, followed by the pound sign. To enter today’s date press 
the pound sign.
9.	Enter the date of service that you are checking followed by the pound sign. For instance, January 4, 
2004, would be entered as 01042004#. If you are using the current day as the date of service press 
the pound sign and wait. 
AVR sends your verification. Your response will be returned momentarily. Refer to the AVR 
Verification Messages section.
Verifying Eligibility by the Member’s Last Name, First Initial, Date of Birth, and Gender
After following steps 1-6 above, follow steps 7-15 below to verify MassHealth eligibility when using a 
member’s last name, first initial, date of birth, and gender.
7.	Press 3 to verify eligibility using a member’s last name and first initial. This is the prompt you will 
hear for entering the name.
Enter up to 20 characters of the member’s last name followed by the pound sign.  Entering letters on a 
touch-tone phone requires 2 presses for each letter. First, press the key that has the letter you need to 
enter. Next, press 1, 2, or 3 representing the position of the letter on that key. Enter Q as 1, then 1 again, 
and Z as 1, then 2. For example, for the letter A, press 2, then 1; for the letter B, press 2, then 2.
8.	Enter up to 20 letters for the member’s last name followed by the pound sign. You will then hear a 
confirmation of the name you have entered.
You have selected [AVR will repeat the name you have just entered]. Press 1 to confirm this selection. 
Press 2 to change your selection.
9.	Press 1 to confirm your selection or 2 to change your selection. The following is the prompt you 
will hear for entering the first name.
 
Enter up to 15 characters of the member’s first name followed by the pound sign. Enter the full 
name for best results.
10.	Enter up to 15 letters for the member’s first name followed by the pound sign. The following is the 
prompt you will hear for entering the member’s first name.
You have selected [AVR will repeat the name you have just entered]. Press 1 to confirm this selection. 
Press 2 to change your selection.
11.	Press 1 to confirm your selection or 2 to change your selection. The following is the prompt you 
will hear for selecting the gender.
Enter the gender for this member. For male, press 1. For female, press 2.
12.	Press 1 if the member is male or 2 if the member is female. The following prompt is for entering 
the member’s date of birth.
Enter the member’s date of birth in MMDDYYYY year format followed by the pound sign.
13.	Enter the member’s date of birth following the above format. The following prompt is for entering 
the date of service.
Enter the date of service in MMDDYYYY year format, followed by the pound sign.
14.	Enter the date of service that you are checking followed by the pound sign. For instance, January 
4, 2004, would be entered as 01042004#. If you are using the current day as the date of service 
press the pound sign.
AVR sends your verification. Your response will be returned momentarily.
AVR Messages
Verification Messages
(Information in italics and in parentheses is filled in by AVR.) 

Primary Prompts
Explanation
Action 
Required
Member ID (Member ID) is 
deactivated.
Active ID (Active ID) should 
be used.
The ID requested is inactive. The new active ID 
should be used in place of old ID.
No action 
required.
For Member ID (member 
ID), member’s date of birth 
is (member’s date of birth).
		
For date of birth
Press #.
Local office # is (phone 
number).	
For local office/MEC	
Press #.
Phone number is (phone 
number).	
Member phone number	
Press #.
(Table continued on next page.)


Verification Messages (cont.) 

Primary Prompts
Explanation
Action 
Required
Member is eligible for 
(benefit plan).	 

Several possible benefit plans. Visit 
www.mass.gov/masshealth for more 
information.
Press #.
Member is ineligible on date 
of service (date of service).
		
Member is ineligible for date of service.
Press #.
Benefit plan is not on file. 
Call MassHealth Customer 
Service for assistance at 1-
800-841-2900.		
The plan does not exist on the AVR tables as an 
exact match to what was sent from NewMMIS.
Press #.
Member is a resident of a 
long-term-care facility with 
NPI (NPI). Phone number is 
(phone number).	
For long-term care
Press #.
For long-term-care approval 
of medical services, call their 
long-term-care facility at 
(phone number).	
If the long-term-care NPI is not populated	
Press #.
Case mix score is (case mix 
score).
If case mix score exists
Press #.
Member has other insurance 
with (TPL carrier name-if 
one of top 25 carriers OR 
carrier code).
For third-party liability
No action 
required.
Policy number is (policy 
number).	
If policy # exists	
No action 
required.
Coverage codes are 
(coverage codes).
Coverage codes for third-party liability
Press #.
For PCC approval of medical 
services call (PCC provider 
name if available) at (phone 
number).
OR
For PCC approval of medical 
services, call your primary 
care clinician at (phone 
number).
Member has been assigned to a PCC; the PCC 
must authorize most services for PCCP 
members. Phone number for provider. 



If PCC provider name is not in the AVR table 
or does not match exactly
Press #.



 
Verification Messages (cont.) 

Primary Prompts
Explanation
Action 
Required
Member also eligible for 
Commonwealth Care.
Member is enrolled with 
(managed care provider 
name) at (phone number).
OR
Managed care name was not 
on file. Call MassHealth 
Customer Service for 
assistance at 1-800-841-
2900.	
Member eligible for Commonwealth Care 


Enrolled with a managed care provider




MCO provider name does not have an exact 
match on the AVR table.

Press #.
Assignment plan is 
(assignment plan).	

One of several possible assignment plans. Visit 
www.mass.gov/masshealth for more 
information.
Press #.
Coverage to begin on 
(coverage begin date).
Managed care coverage information
Press #.
For mental health/substance 
abuse service authorization, 
call the (Partnership) at 
(phone number).
If there is a behavioral health provider, the 
name and phone number are given here.
Press #.
Personal deductible is 
$(personal deductible).
If there is a deductible amount
Press #.
Spenddown is $(spenddown 
amount).	
If there is a spenddown amount for a 
spenddown provider	
Press #.
Pharmacy copay cap status is 
met.
OR
Pharmacy copay cap status is 
exempt.
OR
Pharmacy copay cap status is 
not met.
Pharmacy copay cap status of the member
No action 
required.
Nonpharmacy copay cap 
status is met.            
OR
Nonpharmacy copay cap 
status is exempt.      
OR
Nonpharmacy copay cap 
status is not met.	
Nonpharmacy copay cap status of the member
Press #.
(Table continued on next page.)


 
Verification Messages (cont.) 

Primary Prompts
Explanation
Action 
Required
Tracking number for this 
inquiry is (tracking number).
		
Tracking number assigned
Press #.
Press the pound sign to 
continue.		
Required to continue to next step
Press #.
To perform another 
eligibility inquiry by member 
ID, press 1. To perform 
another eligibility inquiry by 
SSN or other agency ID, 
press 2. To perform another 
inquiry by name, press 3. To 
end this call, hang up. For 
assistance, press 8. To repeat 
this information, press 9.
Eligibility inquiry is complete.
Start 
another 
eligibility 
inquiry, or 
hang up to 
end call.
Note: It is important to obtain the entire message for full details of restrictions. Otherwise, you risk 
denial of your claim. If you have questions about the types of services covered under a specific benefit 
plan, consult your MassHealth provider manual located at www.mass.gov/masshealth. For additional 
information call MassHealth Customer Service at 1-800-841-2900.
Call Termination Messages 

Message
Description of Message
You have reached the limit for inquires. To 
end this call, hang up. For assistance, press 8. 
To repeat this information, press 9.
The maximum number of eligibility inquiries per 
telephone call is five during business hours.
You have exceeded the time limit allotted 
since your last response. Please review the 
procedures in your MassHealth provider 
manual or call 1-800-841-2900 for assistance. 
Thank you for calling MassHealth.
You are allowed six seconds to enter data after 
you have received an instruction from AVR.
You have exceeded the limit for input errors. 
Please review the procedures in your 
MassHealth provider manual or call 1-800-
841-2900 for assistance. Thank you for 
calling MassHealth.
At all entry steps, you are allowed three attempts 
to correctly enter the requested data.
Thank you for calling MassHealth.
The eligibility inquiry has ended.


Error Messages
All error messages are followed by a prompt that tells you the valid data that needs to be entered to 
proceed. 

Message
Resolution
Invalid selection. Please reenter.
You pressed an incorrect key, or a key that had no options 
associated with it. Verify that the correct key was pressed for 
the option needed. Listen to the menu once more, and select an 
available option.
Invalid NPI or provider number 
(provider number). Please 
reenter.
Make sure the NPI or provider number entered was correct. 
Your provider number should be the nine-digit MassHealth 
provider number followed by a one-character location code. 
Your NPI number should be the 10-digit MassHealth NPI 
number.
Invalid user name. Please 
reenter.
Make sure that you have entered at least four characters and 
not more than 16 characters.
Invalid password. (The 
keystrokes entered are repeated, 
but the case is not stated.) The 
password must be at least eight 
characters. Please reenter.
Make sure that you have entered at least eight characters and 
not more than 16 characters.
Invalid password. (The 
keystrokes entered are repeated, 
but the case is not stated.) The 
password may not be greater 
than 16 characters. Please 
reenter.
Make sure that you have not entered more than 16 characters.
Invalid member ID. Please 
reenter.
Make sure the number used is correct. The member ID can be 
found on the member’s MassHealth card. Common errors 
include not entering all digits, entering too many digits, or 
entering a social security number (SSN) rather than the 
member ID.
Invalid ID. Please reenter.
Make sure that the SSN or other agency ID used is correct. 
Otherwise, try entering the member’s ID, if available. The 
member ID can be found on the member’s MassHealth card.
 
(Table continued on next page.)


 
Error Messages (cont.)

Message
Resolution
Invalid last name. Please reenter.
The patient’s last name was not entered correctly. Enter up to 
20 characters for the patient’s last name. Refer to the 
Alphabetic Character-to-Number Conversion for AVR table 
below for entering alphabetic characters on a touch-tone 
phone.
Invalid first name. Please 
reenter.
The patient’s first name was not entered correctly. Enter up to 
15 characters for the patient’s first name. Refer to the 
Alphabetic Character-to-Number Conversion for AVR table 
below for entering alphabetic characters on a touch-tone 
phone.
Invalid date. Please reenter.
Date of service and date of birth should be entered in 
MMDDYYYY format with eight digits. For example, January 
4, 2004, is entered as 01042004. Also, date of service and date 
of birth cannot be set in the future.
The user name and password 
combination you entered could 
not be found. Please reenter both 
the user name and password.
The user name and/or password entered did not match the 
system data. You will need to enter both fields again. Please 
remember these fields are case sensitive, and the entry error 
could likely be related to case. Refer to the charts on the next 
page for assistance.



Alphabetic Character-to-Number Conversion for AVR
The tables below indicate how to enter three characters for any letter, uppercase and lowercase, when 
entering your user name and password. Case is not an issue when entering the member name. 

Use these values for uppercase letters. Do not 
precede with * when inquiring by member’s 
name.
Alpha Character
Touch-tone Keys
A
*21
B
*22
C
*23
D
*31
E
*32
F
*33
G
*41
H
*42
I
*43
J
*51
K
*52
L
*53
M
*61
N
*62
O
*63
P
*71
Q
*11
R
*72
S
*73
T
*81
U
*82
V
*83
W
*91
X
*92
Y
*93
Z
*12



Use these values for lowercase letters.
Alpha Character
Touch-tone Keys
a
*24
b
*25
c
*26
d
*34
e
*35
f
*36
g
*44
h
*45
i
*46
j
*54
k
*55
l
*56
m
*64
n
*65
o
*66
p
*74
q
*14
r
*75
s
*76
t
*84
u
*85
v
*86
w
*94
x
*95
y
*96
z
*15



Contact Information
For questions about the operation of the Automated Voice Response (AVR) system or dialing 
procedures, please call MassHealth Customer Service at the toll-free number below. For immediate 
assistance, please call between 8:00 A.M. and 5:00 P.M., Monday through Friday. At other times, you 
may leave a message for prompt resolution on the next business day.
MassHealth Customer Service		1-800-841-2900
If you need immediate access to EVS for member eligibility information, please call:
Automated Voice Response			1-800-554-0042
Access our Web site at www.mass.gov/masshealth.
Contact MassHealth by e-mail at providersupport@mahealth.net.
Contact MassHealth in writing at the following address.
MassHealth Customer Service
Attention: Provider Services
P.O. Box 9118
Hingham, MA 02043
For questions about discrepancies in member eligibility information, please call the cardholder’s local 
office/MEC. If you have any suggestions on how to improve EVS, please contact MassHealth Customer 
Service at the above address.


Glossary
Term
Description
Asterisk
The * symbol
AVR
Automated Voice Response. The system that permits eligibility 
inquiries to be made directly to, and responses to be heard from 
EVS by using a telephone to call (800) 554-0042.
Data
Information to be entered
EVS
Eligibility Verification System
EVSpc Software
Eligibility Verification System PC Software
HIPAA
Health Insurance Portability and Accountability Act
MassHealth
The Massachusetts Medicaid program
MassHealth Customer 
Service
1-800-841-2900
MassHealth ID card
The ID card issued to every MassHealth member.
Member ID number
The 12-digit number on the MassHealth card appearing next to the 
member’s name.
National Provider 
Identifier (NPI) 
Numeric value federally mandated and assigned to each provider 
by the National Plan and Provider Enumeration System (NPPES).
PC Software
Computer software that can be installed on your PC to verify 
MassHealth eligibility or claim status. It is also referred to as 
EVSpc Software.
PCC
Primary Care Clinician
PCCP
Primary Care Clinician Plan
Pound sign
The # symbol
Provider Number
Numeric value assigned to each provider enrolled with 
MassHealth
TPL
Third-Party Liability. Other insurance coverage that can be used to 
cover medical expenses.



AVR-UG (Rev. 04/09)


Automated Voice Response (AVR) User Guide		
Page 17		April 2009