Verify medicaid eligibility and benefits for providers

Q: How do I check my Medicaid status in Colorado?

You can check if your Health First Colorado (Colorados Medicaid Program) coverage is active by going to the Colorado PEAK website and clicking on the Check My Benefits button or you can view your card from the Health First Colorado mobile app.

MassHealth Customer Service Center for Providers

The Details of Eligibility Verification for Providers

the Contents of the Eligibility Verification for Providers page

Table of Contents Show

MassHealth Customer Service Center for Providers
The Details of Eligibility Verification for Providers
the Contents of the Eligibility Verification for Providers page
What you need for Eligibility Verification for Providers
How to check Eligibility Verification for Providers
Downloads for Eligibility Verification for Providers
Contact for Eligibility Verification for Providers
Customer Service Promise
Human Trafficking GET HELP
Medicaid and Child Welfare Specialty Plan
Comprehensive Long Term Care
Verifying Member Eligibility
Methods to Verify Eligibility
How do I check my Medicaid status in Florida?
How do I check my Medicaid status in Colorado?
How do I check my Medicaid status in Louisiana?
How do I get proof of Medicaid in Ohio?

What you need for Eligibility Verification for Providers

Your Provider Online Service Center (POSC) login information
Your MassHealth Provider ID/Service Location Number
The date(s) of service
Any of the following member information:
- 12-digit member ID
- Social security number (SSN)
- Other Agency ID (DCF and DYS)
- First name, last name, date of birth, and gender

How to check Eligibility Verification for Providers

Access member eligibility information from the EVS Internet site through the POSC.
Click Manage Members.
Click Eligibility.
Click Verify Member Eligibility. The Check Member Eligibility panel is displayed.
On the Check Member Eligibility panel, select the provider from the drop-down list.
Enter either the member's:
- 12-digit Member ID
- SSN
- Other Agency ID (DCF and DYS)
- First name, last name, DOB and gender
In the From Date of Service and To Date of Service fields, enter the date range for the search.
Click Submit.
On the Member Information tab: Confirm the member’s information.
Once you have confirmed the member’s information, click the Eligibility tab.
On the Dates of Eligibility panel, click Verify Eligibility Status.
After verifying the member’s eligibility status, do one of the following:
- To end the process, click Close.
- To verify another member’s eligibility, click Perform Another Eligibility Check.
Click the "print" button on your browser to print a paper copy of the member's eligibility verification. Save this for your records.

Downloads for Eligibility Verification for Providers

Contact for Eligibility Verification for Providers

Eligibility Verification System Overview
MassHealth Copay Information – For Providers

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Utah Medicaid has recently upgraded our security for the Eligibility Lookup Tool. All users must re-register in order to use the system. Please use the same email address to link your account. To register, click here.

The Eligibility Lookup Tool is a website that allows a provider to electronically view a member’s Medicaid eligibility and plan enrollment information. The Eligibility Lookup Tool will also tell you if the patient is restricted to a specific provider and if the patient is responsible for co-pays.

To verify your patient’s eligibility on the portal you will need the information off of the Medicaid card which includes member’s name, Medicaid ID and date of birth. A provider must also have a Provider ID (NPI or API) known to Medicaid.

In order to be in compliance with HIPAA, we must assure that only those that have the right to this information have access. A provider will have to register with the State of Utah by creating an account. If not currently logged in, you will be redirected and prompted to log in. Due to security, there is a 20-minute inactivity timeout feature on the Eligibility Lookup Tool.

Eligibility Lookup Tool

Providers are responsible for verifying eligibility every time a member is seen in the office. PCPs should also verify that a member is assigned to them.

Medicaid eligibility in Florida is determined either by the Department of Children and Families (DCF) or the Social Security Administration (SSA), which determines eligibility for individuals receiving Supplemental Security Income (SSI). DCF determines Medicaid eligibility for:

Parents and caretaker relatives of children
Children
Pregnant women
Former foster care individuals
Non-citizens with medical emergencies
Aged or disabled individuals not currently receiving Supplemental Security Income
(SSI)

Medicaid and Child Welfare Specialty Plan

Until the actual date of enrollment with Sunshine Health, Sunshine Health is not financially responsible for services the prospective member receives. In addition, Sunshine Health is not financially responsible for services members receive after coverage is terminated. However, Sunshine Health is responsible for anyone who is a Sunshine Health member at the time of a hospital inpatient admission and changes health plans during that confinement.

Comprehensive Long Term Care

Sunshine Health is responsible for providing LTC services once the Florida Department of Elderly Affairs determines an enrollee meets the medical requirements for nursing home level of care and the enrollee formally selects the Sunshine Health Comprehensive plan through AHCA’s Choice Counseling. Following that selection, the Department of Children and Family Services (DCF) determines if the member meets the financial criteria. Once AHCA receives confirmation of a member’s eligibility, AHCA notifies Sunshine Health of the member’s effective enrollment date. Coverage typically lasts for a year until DCF recertifies the member. During the annual recertification process, Comprehensive members may receive a 60-day extension of coverage and their benefit category is changed to “SIXT” on the secure provider portal of AHCA’s website.

Verifying Member Eligibility

Sunshine Health recommends providers verify eligibility before rendering services for our MMA and CWSP members and at least monthly for Comprehensive members. Providers may use the provider portal to verify member eligibility or use the tools and resources provided by AHCA for that purpose.

Providers must verify a member’s eligibility each time a Sunshine Health member schedules an appointment and arrives for services. Because members may change PCPs and MMA plans, PCPs should also verify that a member is their assigned member. Sunshine Health must authorize all services before providers render any LTC-covered service for Comprehensive members.

Methods to Verify Eligibility

Providers are asked to verify member eligibility by using the Sunshine Health secure provider portal. Using the portal, any registered provider is able to quickly check member eligibility by indicating the date of service, member name, and date of birth or the Medicaid ID number and date of birth.
Providers may call Provider Services at 1-844-477-8313. Providers are asked to supply the member’s name and date of birth or the member’s Medicaid identification number and date of birth.

How do I check my Medicaid status in Florida?

Dial the AVRS at 1-800-239-7560.

How do I check my Medicaid status in Colorado?

You can check if your Health First Colorado (Colorado's Medicaid Program) coverage is active by going to the Colorado PEAK website and clicking on the Check My Benefits button or you can view your card from the Health First Colorado mobile app.

How do I check my Medicaid status in Louisiana?

Who can tell me if I have Medicaid health coverage? If you are not sure if you have Medicaid health coverage, call Medicaid Customer Service toll free at 1-888-342-6207.