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Eligibility Verification System (EVS) Topics:

• webDENIS
• AVRS: 1-888-696-3510
• Emdeon (formerly Medifax)
• HDX - EDI Services
• Verifying Eligibility with the mihealth card
• EVS Search methods
• Information available on the EVS
• Eligibility Policy
• Provider L-Letters
• Need more information

• web-DENIS is BCBSM's secure browser-based internet site for eligibility verification.
• Eligibility information for Medicaid, CSHCS, MOMS, ABW, and MIChild is available including Pending Eligibility.
• Providers can also print the eligibility response to use for documentation of coverage. 
• ANSI, ASC X12N 270/271 transaction is also available. Contact BCBSM at 1- 800-542-0945 and/or  click here for more information .
• Available to MI Medicaid Providers free of charge. 

To obtain access into web-DENIS, please review the following instructions:

• Participating BCBSM Providers with current access to web-DENIS:  Click Here  
• Participating and Non-Participating BCBSM Providers without access to web-DENIS:  Click here

webDENIS Response Examples:

• Fee for Service Medicaid (with Other Ins.): Click Here
• Medicaid - Enrolled in a Health Plan: Click Here
• Pending Eligibility:  Click Here
• Deductible - No Coverage:  Click Here
• No coverage: Click Here
• Fee for Service ABW: Click Here
• ABW - Enrolled in a County Health Plan: Click Here
• MOMS and Emergency Medicaid: Click Here
• CSHCS: Click Here
• MIChild: Click Here

Need more information:

• PowerPoint Presentation with Response Examples: Click Here
• Provider Letter (L 05-25):  Click Here

• Available to all MI Medicaid Providers by calling 1-888-696-3510 (toll free).
• To access the AVRS: Effective October 1, 2007, providers must use their NPI number (Note: HIPAA exempt providers are excluded and can continue to use their 7 digit provider ID number and 2 digit provider type number).
• Several  search methods  to find the beneficiary.
• Voice or faxed back eligibility responses.
• Available: 24 x 7 x 365
• No cost for MI Medicaid providers.

AVRS - Fax Back Eligibility Response Examples:

• Current Eligibility Response: Click Here
• Pending Eligibility Response: Click Here
• MIChild Eligibility Response: Click Here
• Record "Status" clarification: Click Here  

AVRS User Manual:

• Current Eligibility Database: Click Here
• Pending Eligibility Database: Click Here
• MIChild Eligibility Database: Click Here

• Offers Electronic Data Interchange (EDI) eligibility verification products/services.
• Magnetic swipe technology is also available.      
• There is a charge to the provider for these EDI products/services. 
• Emdeon EDI Products: Click Here  
• Emdeon EDI User Manuals: Click Here  

EDI - Eligibility Response Example:

• Response Example: Click Here
• Record "Status" clarification:  Click Here  

Need more information:

• Phone: 877-469-3263
• E-mail: BusinessServicesSales@emdeon.com  
• Website: www.emdeon.com  (Information and EDI user manuals)

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Healthcare Data Exchange (HDX) - EDI Services for Eligibility

• HDX offers integrated EDI eligibility verification services.
• There is a charge to the provider for these EDI services.

Need more information:

• Phone: 1-866-HDX-EDI1 (1-866-439-3341 )
• E-mail: Webmaster@hdx.com
• Website: Click here  

Verifying Eligibility with the  mihealth card :

• Use the beneficiary ID number search method  and "Key-In" the ID number (located on the front of the mihealth card ).
• "Swipe" the mihealth card using Magnetic swipe technology available thru  Emdeon .
• Additional  search methods  are available if a beneficiary does not have the mihealth card. 

Use one of the following search methods to find and access a beneficiary's eligibility information on the EVS: 

1. Beneficiary ID number  (8-digit or 10-digit ID located on front of the mihealth card).

2. Beneficiary social security number and date of birth.

3. Beneficiary name and social security number (or date of birth).

4. Client Identification Number (CIN) (MIChild Inquiries only).

• Eligibility information for Medicaid, CSHCS, MOMS, ABW, and MIChild
• Pending Eligibility
• Other eligibility information: Public Assistance Medical Assistance (PAMA) program code,  scope/coverage codes , patient-pay amounts, CSHCS provider authorization information, and  Level-of-care (LOC) codes
• Health Plan enrollment information for Medicaid, CSHCS and ABW.  Information will include the LOC code with description, health plan name, provider ID, and phone number.
• Beneficiary information: name (on file), gender, date of birth, recipient ID number and case number.
• DHS information : County name ,  office phone number , and case worker load number.
• Dental information: Fee for Service or Delta Dental (Premier or Preferred).
• Third-party liability (TPL) information (if on file): carrier ID , carrier name , carrier address, other insurance code, policy number, policyholder name, contract number, control number, services code and employer name.
• Note: If the TPL listed on the EVS is no longer active or if is not being reported in the response, please contact Provider Inquiry at 1-800-292-2550 (Option # 4).

• Provider Manual: Click Here  
• Go to the Beneficiary Eligibility Chapter: Section 3 - Verifying Beneficiary Eligibility

• L03-04
• L05-24
• L05-25

Contact Provider Inquiry:

• MDCH/Provider Inquiry
  P.O. Box 30731
  Lansing, MI 48909-8231
• Phone: 1-800-292-2550
• E-mail: ProviderSupport@michigan.gov  

The mihealth card:

• Click here