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If the person claims to be a MetroPlus member and does not have a member ID card, the Provider must call Customer Services and advise a Customer Services Representative that the member cannot produce a member ID card. The Customer Services Representative will ask to speak directly to the member to verify the member's identity and give the Provider the member's identification number that can be used for claim submission and written confirmation of eligibility.
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A member who recently transferred from one PCP to another may have not yet received their new card that shows the name of their new PCP; eligibility for these members must be verified through MetroPlus Customer Services.
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Fax Recall System: Call 800-303-9626 and follow the instructions to select the fax recall option to receive a fax outlining the member's eligibility. Enter the member's identification number and a ten digit return fax number (omit the 1 before the area code). Use the corresponding number on the telephone keypad to enter any letters in the code (for Q use 7 and for Z use 9). The member's name will not be included on the fax for reasons of confidentiality. The fax recall system is available twenty-four hours per day, seven days per week. |
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Online Verification: Eligibility can also be verified by logging on to the MetroPlus Provider portal. Up to ten members may be verified at one time.
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Electronic Medicaid Eligibility Verification System (EMEVS): For Managed Medicaid, FHP and HIV SNP members, the Medicaid Client Identification Number (CIN) may be used to check eligibility through the EMEVS website. EMEVS is available from 9 am to 7 pm daily. However, sites with the ability to "swipe" Medicaid cards to access eligibility information will not be able to verify FHP coverage in this manner. EMEVS does not identify a member's PCP.
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