The Eligibility Verification System (EVS) provides important information about MassHealth members. By checking EVS before providing services to a MassHealth member, you reduce the risk of denied claims.

EVS gives you easy access to current and complete member eligibility information on the date or date range on which services are provided. It is available 24 hours a day, seven days a week. If you do not verify a member's eligibility before providing services, you might not be paid for those services. By verifying eligibility, you learn

  • the member's eligibility status;
  • the member's MassHealth coverage type;
  • managed-care information, if applicable;
  • coverage restrictions, if applicable;
  • other insurance information, if applicable;
  • long-term-care information, if applicable; and
  • the member's local office identification number, if applicable.

The new claim status feature enables you to inquire about the status of MassHealth benefit claims. A claim status request may be made using

  • an internal control number (ICN);
  • the patient account number (PAN); or
  • the member's MassHealth  ID number.

The claim status response provides detailed information about the status of benefit claims submitted to MassHealth. By submitting a claim status request, you learn the following:

  • provider number and provider name;
  • 12-digit MassHealth member ID number;
  • member's full last name, full first name, and middle initial;
  • date of birth on record for the member;
  • gender on record for the member;
  • last date that the status of the claim was updated;
  • amount submitted on the claim;
  • payment made by MassHealth;
  • date that the claim was adjudicated by MassHealth;
  • date that the remittance advice for this claim was sent to the provider;
  • provider's internal tracking number for that MassHealth member;
  • dates of service submitted on the claim;
  • service code submitted on the claim; and
  • units of service submitted on the claim.





 

This information is provided by MassHealth .