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AEVS Eligibility Verification Message for Cal MediConnect Recipients

September 4, 2015

Effective September 2015, the Department of Health Care Services (DHCS) will update the Automated Eligibility Verification System (AEVS) with a new message. The message concerns the eligibility of recipients enrolled in a Cal MediConnect plan.

If a recipient loses Medi-Cal eligibility, but is reasonably expected to regain eligibility within two months, Cal MediConnect plans can choose to provide a one-month or two-month period of deemed eligibility. If the recipient is deemed eligible, providers will receive the following message:

“SUBSCRIBER LIMITED TO SERVICES COVERED BY HEALTH PLAN: (HCP) [Plan Name], (HCP phone number) 1-800-###-####.”

This change will only apply to Cal MediConnect recipients in a deeming period (a period in which the beneficiary is deemed eligible). In these instances, the recipient is active in the Cal MediConnect health care plan and is limited to those services.

To verify covered services, providers should contact their health care plan. Providers can advise recipients to contact their county case workers to resolve their Medi-Cal eligibility issues.