Eligibility Verification System Overview

The Eligibility Verification System (EVS) provides important benefit information about MassHealth members. Providers must check EVS before providing services to MassHealth members.

EVS is available through the Provider Online Service Center (POSC). EVS provides easy access to current and complete member eligibility information on the date or date range in 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.

Eligibility verifications though POSC can be performed via Direct Data Entry (DDE) for a single member verification or via Batch for checking multiple member verifications at the same time.

Submitting Batch Transactions

MassHealth providers and vendors submitting transactions in conformance with Phase I CORE 155: Eligibility and Benefits Batch Response Time Rules, and in accordance with HIPAA ASC X12 and MassHealth policy, must follow these submission guidelines to ensure timely and efficient processing of transactions.

  1. ONLY check eligibility for those MassHealth members you will actually provide services to on that day or the following day.
  2. DO NOT submit your entire roster of MassHealth members unless you are providing services for your entire roster of members the same day or the following day.
  3. DO NOT include more than 3,000 members in any single eligibility batch file request. The 270/271 HIPAA Implementation Guide requires that the 270 transaction contain no more than 99 patient requests when using the transaction in batch mode, though it allows other patient request limits to be set. MassHealth agreed to the reasonable limit of up to 3,000 member requests per transaction. Transactions exceeding this limit were rejected beginning on May 8, 2015. MassHealth reserves the right to modify this limit as required, in accordance with the HIPAA standard.
  4. YOU MUST INCLUDE the member’s Medicaid Identification Number on the eligibility request, if known.
  5. POPULATE ALL subsequent eligibility requests with the member information received from MassHealth on the prior eligibility response, where applicable.

It is important that you follow these file submission guidelines to ensure a timely response to your file submission.

If you have any questions, contact us at (800) 841-2900.

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