Eligibility Information Expanding to 36 Months

Beginning February 1, 2016, providers will be able to obtain Medicaid, Health Choice, and Public Health eligibility information for a recipient going back as far as 36 months prior to the current month. This is a significant enhancement to the 12 months of eligibility information currently available. The expanded eligibility information will be available through all channels, including the Automated Voice Response System (AVRS), the secure provider portal, and the X12 270/271 transactions.

With this system enhancement, providers will be able to request from 1 (one) to 12 (twelve) consecutive months of eligibility information about a recipient (13 months if the current month is included in the request). The date(s) requested can be up to 36 months prior to the current month. An error message will be returned for all inquiries submitted for more than the 12/13 consecutive month span or dates beyond the 36 months prior to the current month.

Note: AVRS users can only enter one date, not date spans. Eligibility responses on the portal will be displayed one month at a time, which is the current functionality.

Prior to February 1, the Health Care Eligibility Benefit Inquiry and Response (270/271) Companion Guide will be updated to include this enhanced capability and posted on the Trading Partner Information page of the NCTracks Provider Portal. The AVRS Features Job Aid under Quick Links on the Provider Portal Home Page will also be updated.

This change applies to eligibility information for recipients of services from the N.C. Division of Medical Assistance (DMA) and the Division of Public Health (DPH) and does not affect the existing rules governing future eligibility. DPH will continue to allow eligibility inquiries for up to 12 months beyond the end of the current month. DMA will continue to not allow dates beyond the end of the current month in an eligibility inquiry.