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AEVS Message Issue Relating to the Medi-Cal County Inmate Program

October 27, 2017

The Department of Health Care Services (DHCS) is working to resolve issues relating to Automated Eligibility Verification System (AEVS) messages that providers are receiving when verifying Medi-Cal eligibility for inmates.

The following two messages are being received:

Message 1: SUBRCRIBER MEDI-CAL COVERAGE HAS BEEN SUSPENDED, CONTACT COUNTY WELFARE AGENCY FOR MORE INFORMATION.

This AEVS message is prompted when there is a suspension indicator in the beneficiary’s eligibility record, even when there is an active Medi-Cal County Inmate Program (MCIP) aid code present. Instead, the AEVS message should read: MEDI-CAL ELIGIBLE LIMITED TO SERVICES PROVIDED ONLY IN AN INPATIENT HOSPITAL FACILITY.

Message 2: PRMY AID CODE: XX. 2ND SPECIAL AID CODE: XX. MEDI-CAL ELIGIBLE LIMITED TO SERVICES PROVIDED ONLY IN AN INPATIENT HOSPITAL FACILITY.

This AEVS message is prompted when there are active benefits for both the non-MCIP aid code and the MCIP aid code. The non-MCIP aid code should be suppressed and AEVS should only read: MEDI-CAL ELIGIBLE LIMITED TO SERVICES PROVIDED ONLY IN AN INPATIENT HOSPITAL FACILITY.

DHCS anticipates a resolution to these messages by January 2018. In the interim, verify eligibility with the county welfare department prior to submitting claims when receiving Message 1. When Message 2 displays, Medi-Cal eligibility is verified and claims may be submitted.

For questions regarding this notice or any eligibility-related questions, email MCIEP@dhcs.ca.gov. For any claims/billing issues or questions, please email DHCSIMCU@dhcs.ca.gov.