Your Texas Benefits Card

Transcription

1 Your Texas Benefits Card Provider Interactive Voice Response User Guide How to Access and Use the Provider IVR System to Access Medicaid Member Information Updated: October 10, 2013

2 Table of Contents Table of Contents Section 1 Option 1: Medicaid Providers Main Menu... 5 Section 2 Option 2: Medicaid Provider with API Main Menu... 6 Section 3 Option 3: Non-Enrolled Medicaid Provider or Pharmacist Main Menu... 7 Page 2 of 7

3 Introduction The Texas HHSC Provider Interactive Voice Response (IVR) system allows Medicaid providers to access relevant information about Medicaid members, such as Medicaid eligibility or health history. Providers can use this helpline any time of day or night to check a member s benefits and eligibility. Providers can also get the same information by visiting This guide is intended as an introduction to the Texas HHSC Provider IVR system. Passages in italic are quoted from the IVR system s voice-menu. The IVR system is reached by dialing the toll-free number Callers to this number will hear the following greeting: Welcome. You have reached the Provider Help Desk for the Your Texas Benefits Medicaid Card. We can answer your questions about verifying Medicaid eligibility, help you access a Medicaid member s health history, or help you with the Your Texas Benefits Medicaid Card website or system. From the Main Menu, you will be able to select from the following options: If you are a Medicaid provider, press 1. If you are a Medicaid provider with an API, press 2. If you provide services to Medicaid clients but are not enrolled as a Medicaid provider, or you are a pharmacist, press 3. To speak to a customer service representative, press 9. These functions are described in the chapters below. Page 3 of 7

4 Option 1: Automation Support Main Menu Page 4 of 7

5 Option 2: Medicaid Providers Main Menu Section 1 Option 1: Medicaid Providers Main Menu This menu is for providers who need to enter or access information about Medicaid members. 1. You will be prompted to log in by entering the billing provider s National Provider Identifier (NPI), the last four digits of the Tax ID, and the ZIP code. 2. After successful login, select from the following choices: To enter or access information about a person who is covered by Medicaid, press 1 (client assistance). To hear this menu again, press the star key ( ). To speak to a customer service representative, press If you press 1, you will hear the Client Assistance Menu: Enter the member s Medicaid ID. Enter the member s date of birth in the month-day-year format. For example, if the birth date is June 15, 2001, enter You will then hear the eligibility information menu: o To check-in the person with Medicaid, press 1. o To hear this member s Medicaid health summary, press 2 (only Immunizations are available at this time). o To repeat the member s program information, press 3. o To return to the main menu, press the pound key (#). o To speak to a customer service representative, press 9. o To hear this menu again, press the star key ( ). o To end this call, please hang up. Page 5 of 7

6 Option 3: Non-Enrolled Medicaid Provider or Pharmacist Main Menu Section 2 Option 2: Medicaid Provider with API Main Menu This menu is the same as Option 2, but allows a provider to log in with a 10-digit Atypical Provider Identifier (API), instead of a nine-digit NPI. 1. You will be prompted to log in by entering the billing provider s API number, Tax ID, and ZIP code. 2. After successful login, select from the following choices: Are you helping a person who is covered by Medicaid? Press 1. (Client Assistance) To hear this menu again, press To speak to a customer service representative, press 9. If you press 1, you will be directed to the Client Assistance Menu: Enter the member s Medicaid ID. Enter the member s date of birth in the month-day-year format. For example, if the birth date is June 15, 2001, enter At this point, the eligibility information plays; make a selection from the following choices: o To check-in the person with Medicaid, press 1. o To hear this member s Medicaid health summary, press 2 only Immunizations are available at this time ). o To repeat the member s program information, press 3. o To return to the main menu, press the pound key (#). o To speak to a customer service representative, press 9. o To hear this menu again, press the star key ( ). Page 6 of 7

7 Option 4: Medicaid Provider with API Main Menu Section 3 Option 3: Non-Enrolled Medicaid Provider or Pharmacist Main Menu This menu provides Medicaid member eligibility information for non-enrolled Medicaid providers. It can also be used by pharmacies to look up a Medicaid member s pharmacy plan name. 1. Enter the member s Medicaid ID. 2. Enter the member s date of birth in the month-day-year format. For example, if the birth date is June 15, 2001, enter If the Medicaid ID number entered is valid, and the member is eligible for Medicaid, make a selection from the following choices from the Client Assistance/Non-Medicaid Provider Eligibility Lookup Menu: o To hear the pharmacy plan name, press 1. o To check eligibility for another Medicaid ID, press 2. o To repeat the Medicaid eligibility status, press 3 o To hear this menu again, press the star key ( ). o To end the call, please hang up. If the ID number entered is not valid, or the member is not eligible, you can either press the star key ( ) and enter another Medicaid ID; or hang up. o Page 7 of 7