Department of Medical Assistance Services

MediCall System

GENERAL INFORMATION	PRIOR AUTHORIZATION INFORMATION
HOW TO USE THE SYSTEM	SERVICE LIMITS INFORMATION FOR PSYCHIATRIC PROVIDER TYPES
ENROLLEE ELIGIBILITY VERIFICATION	SERVICE LIMITS INFORMATION FOR ALL OTHER PROVIDER TYPES
PROVIDER CHECK LOG	PRESCRIBING PROVIDER ID
CLAIMS STATUS

GENERAL INFORMATION

The Virginia Medical Assistance MediCall System offers Medicaid providers twenty-four-hour-a-day, seven-day-a-week access to current enrollee eligibility information, check status, claims status, prior authorization information, service limit information, pharmacy prescriber identification number cross reference, and information to access enrollee eligibility and provider payment verification via a voice response system over the telephone. MediCall is an enhancement to the previous Medicaid Audio Verification Response System (AVRS).

Not only does MediCall offer providers flexibility in choosing the time of day for their inquiries, but it also makes efficient use of staff time. A valid provider number and a touch-tone telephone are required to access MediCall.

To reach an operator while using the enrollee eligibility verification feature of MediCall, key “0” at any prompt within the Enrollee Eligibility menu. Operator assisted calls are limited to three name searches per call. The operator will not be able to return the caller to MediCall for further inquiries. Operators are available from 8:30 a.m. to 4:30 p.m. Eastern time, Monday through Friday except for state holidays.

MediCall prompts the caller throughout the inquiry, giving and receiving only essential, pertinent information. The data provided is the most up-to-date information available, direct from the Medicaid eligibility, claims and remittance databases. If the caller waits too long to respond to a system prompt, the call will be disconnected.

System downtime will be scheduled during non-peak hours. If the caller dials MediCall during this time, the caller will be informed that the system is unavailable. System downtime is typically scheduled for:

2:00 a.m. to 4:00 a.m. Daily
2:00 a.m. to 6:30 a.m. Thursday
10:00 p.m. Saturday to 6:00 a.m. Sunday

The telephone numbers are:

1-800-772-9996	Toll-free throughout the United States
1-800-884-9730	Toll-free throughout the United States
804-965-9732	Richmond and Surrounding Counties
804-965-9733	Richmond and Surrounding Counties

If you have any questions regarding the use of MediCall, contact the Medicaid Provider “HELPLINE.” The HELPLINE is available Monday through Friday from 8:30 a.m. to 4:30 p.m., except State holidays, to answer questions. The HELPLINE numbers are:

1-804-786-6273	Richmond Area and out of state long distance
1-800-552-8627	In state long distance (toll-free)

HOW TO USE THE SYSTEM

To access MediCall, the provider must have a currently active Medicaid provider number. The provider's number is verified before access to MediCall is authorized.

Responses by the caller to MediCall are required within a specified period of time. If the time limit is exceeded, the call will be disconnected. The caller should have the following information available before calling:

Virginia 9-digit Medicaid Provider Identification Number (For 7 digit provider numbers, add two leading zeros.)
Enrollee Medicaid Number (12 digits) or Social Security Number (9 digits) and Date of Birth (8 digits) in month, day, century and year format (mmddyyyy) (necessary for enrollee eligibility verification and claims status)
From and Thru Date(s) of Service in month, day, century and year format (mmddyyyy) (necessary for enrollee eligibility verification and claims status). The caller will have the following limits when entering dates of service
- The caller does not have to enter a Thru date of service if services were rendered on a single day. Pressing the # key prompts the system to continue.
- Future month information is only available in the last week of the current month.
- Inquiries cannot be on dates of service more than one year prior to the date of inquiry.

After dialing the MediCall number, the system will ask for the provider number. Enter the 9-digit number (using two leading zeros for 7 digit numbers). After the number is accepted, the menu will present seven options:

Press “1” for enrollee eligibility verification.
Press “2” for recent check amounts.
Press “3” for claims status.
Press “4” for prior authorization information.
Press “5” for service limit information.
Press “6” for pharmacy prescriber ID verification.
Press “7” for information about Internet access to enrollee eligibility and provider payment verification.

ENROLLEE ELIGIBILITY VERIFICATION

Enter the From and Thru dates of service. The service dates for enrollee eligibility verification cannot span more than 31 days. When the dates of service have been entered, MediCall will verify the information and respond by speaking the first six letters of the last name and the enrollee's Medicaid number for confirmation.

Remain on the line to obtain important enrollee information that might affect payment, such as:

Special Indicator Codes (Copayment)
Client Medical Management Information Including Pharmacy/Physician Telephone Number
Medicare Eligibility
Other Insurance Coverage
Special Coverage (QMB, QMB--Extended)
"MEDALLION" Participation

Managed Care Organization provider name and assignment dates

At this point, MediCall will prompt the caller for the next action. The caller may ask for additional dates of service on this enrollee, or may inquire on another enrollee.

The caller may check up to three dates of service for each enrollee and inquire on up to three enrollees per call.

If the caller is using a Social Security Number instead of the enrollee ID number, the dates of service will relate to the first enrollee ID reported. If multiple open records exist for the same Social Security Number, you will be advised to contact the local department of social services. You will be given a 3-digit city/county code of the appropriate agency and a 5-digit caseworker code. A cross-reference list of the city/county codes is provided as an exhibit to this chapter.

The caller will receive a "not eligible" response if the future dates about which he or she inquires are beyond the information on file.

A response, "not eligible," will be given if the enrollee is not eligible for all days within the time span entered.

PROVIDER CHECK LOG

The most recent check information is presented by invoice type. This inquiry permits the provider to receive check dates and amounts from the most recent three remittances.

CLAIMS STATUS

For claims status information, the MediCall system will prompt the provider to choose the among the following invoice types (additional information in italics).

For inpatient care, press 01.
For long-term care, press 02.
For outpatient hospital, home health or rehabilitation services, press 03.
For personal care, press 04.
For practitioner (physician CMS-1500 billing), press 05.
For pharmacy, press 06.
For independent labs (outpatient lab services), press 08.
For Medicare crossover, press 09.
For dental, press 11.
For transportation, press 13.

For claims status, the From date cannot be more than 365 days in the past. The Thru date cannot be more than 31 days later than the From date. After keying the enrollee identification number and the From and Thru date(s) of service, MediCall will provide the status of each claim up to and including five claims. MediCall will prompt for any additional claims or return to the main menu.

PRIOR AUTHORIZATION INFORMATION

The From and Thru dates for prior authorization cannot span more than 365 days. When the 12-digit enrollee ID number and the 8-digit from and through dates of service have been entered, you will be prompted to enter the 11-digit prior authorization number, if known. If you do not know the prior authorization number, then press the pound (#) key. MediCall will verify prior authorization data on file. The system will prompt you to return additional prior authorization data for the same enrollee and dates, enter new dates for the same enrollee, another prior authorization number for the same enrollee or to enter another enrollee ID number to begin a new inquiry.

SERVICE LIMITS INFORMATION FOR PSYCHIATRIC PROVIDER TYPES

The psychiatric provider can inquire about the following service limits:

For outpatient psychiatric, press 1.
For substance abuse, press 2.
For occupational therapy, press 3.
For physical therapy, press 4
For speech therapy, press 5.
For home health aide, press 6.
For home health skilled nursing, press 7.

SERVICE LIMITS INFORMATION FOR ALL OTHER PROVIDER TYPES

The provider can inquire about the following service limits:

For occupational therapy, press 1.
For physical therapy, press 2
For speech therapy, press 3.
For home health aide, press 4.
For home health skilled nursing, press 5.

For occupational therapy, speech therapy or physical therapy the MediCall system will return non-school based and school based service limits separately.

PRESCRIBING PROVIDER ID

Only enrolled Pharmacy providers can access this choice. When prompted, the caller should enter the license number of the prescriber. MediCall will return the first six letters of the prescriber’s last name and Medical Assistance provider number. If the prescriber is not active in Virginia Medicaid, you will receive a message that the number is not on file.