Medicaid Eligibility Check

Modified on Wed, 12 Oct, 2022 at 10:40 AM



Call Handling Procedure

Employees or our referral Partners are eligible to call in and request a Medicaid Eligibility Check (Medicaid Check, Checking a person) to determine if a person is eligible or qualify for services with TSGCS. 


1. Verify

A.Ask caller their full name to verify they are able to conduct medicaid check 

Verify the caller is a employee in the Employee Directory


If on employee list PROCEED.  Thank you (Caller Name) i was able to verify you.

If NOT, do NOT Proceed and ask person to contact their supervisor. 

Disconnect.


B. Ask May I please have the Full Name (First and Last) and Date of Birth of the person we are conducting the Medicaid Eligibility check on.  


Let caller know: I am going to place you on hold while i perform the Eligibility check for you. It will be a few moments. Thank you. 


Place Caller on Hold.



2. Log 

Open up the Lead Sheet using the link below and Log the person you are running the check on (Name & DOB for now) and add the caller's name in the "Referral Source" tab (Keep sheet open)


https://docs.google.com/spreadsheets/d/1ZOrT6bFUWMw7S3B8UUrr4vcERFMy5MtI/edit?usp=sharing&ouid=105449520400907130879&rtpof=true&sd=true


4. After you conduct the check in step #3 come back here  

 go back to the Lead sheet  and follow these instructions in the green - 


If the person is eligible:


Select the type of plan the eligible person has from the Managing entity field from your search  into the "Medicaid Tab" in the Lead sheet.


Return to caller  (Take off Hold) 

Inform the caller  that _________ is Eligible for our services. We would like to get their intake started.  


Collect Remaining Information 

Ask caller, What is the best contact information (Phone, Email, Address)  for ________(Eligible Person) and best times to reach them. 

*(if homeless, skip address, if no phone or email  find out the best place to find them and best time to find them there, get as much info as you can, ask for the number of a person they talk with everyday)


 

-if caller is with person gather the remaining information below from them to complete Lead sheet.

-if not  with person, tell caller you are going to reach out to person to complete their intake, thank them and end the call. 


(Look up the "Lead Follow up Article" contact the person, following this article and finish the Lead Sheet)


 Remaining Information 

(Availability for Assessment)Enter on Lead Sheet

When is the best time for a video visit with our social worker (Day of week and time of day) 



Intake Forms 

Ask caller, do eligible person have a phone you can send a link for the intake forms to?

-If Yes, using the text feature in ring central, text the following link to the eligible person mobile number.


Intake form link> https://intake.tsgcs.org/ 


(tell them that needs to be completed asap, if they have problems they can contact our office for help with completing their intake packet at 704-55-5392)


- If NO, mark No on the lead sheet for "Intake packet sent" tab


Thank the caller for calling and for being apart of the team and tell them to inform eligible person we will be in touch with them soon. 


If the person is NOT Eligible 

Inform the caller, the person is NOT Eligible for our services at this time. 

(Offer any options available : 

1-if they have a managing organization in their results but its not one on our list, offer them to change their address to our service area or switch plans)   

2- if they just don't have Medicaid, ask caller do they think they may qualify if they apply (Caller must strongly feel they may qualify before giving this option   

If so ask them (Do they have any disability? this is a stronger indicator ) Schedule a time to assist  with Medicaid application. Create a ticket under level one, date ticket for 3 days due date and title Medicaid application assistance     


Thank the caller for calling and for being apart of the team. Disconnect 

On the Lead Sheet enter the Managing entity under the  "Medicaid" field, if any, add any notes, if any. Done. 


3.Conduct Eligibility Check 


The Eligibility Verification System (EVS) is a real time, online system that provides timely and accurate information regarding a recipient's eligibility for services. The Eligibility Verification function is used to determine which benefits a recipient is eligible to receive.


Log on to the NC Tracks system 


https://www.nctracks.nc.gov/ncmmisPortal/loginAction?flow=PP

User ID: tsgadmin1

Password: @Welcometsg1




Click Eligibility on the top blue bar

Basic Information

All 3 fields in this section are required and should be the same as example below. 

Recipient Information: In this Section, only enter the  First, Last Name, and Date of Birth   

Date of service: 

Enter the first day of the current month in the FROM box and the last day of the month in the TO box

 (If the day of the search is closer to the end of the month, use the last day of the following month in the TO section.)

Explicit Inquiry: 

Select MNTL HLTH (Mental Health) from the Service Type box on the left and click add. This will move MNTL HLTH to the Selected Service Types Box on the right 


Click the Check Eligibility button on the bottom  


After Submitting information the result screen will look like the example below:



This is an Example of a Person who is eligible, pay close attention to the areas that are circled in the example. 

Under Benefit Plan it may read: Medicaid or Medicaid or Managed Care Plan 

Under the Managing Entity (Very Important) The Person is only eligible if Managing Entity is one from the list below:

(If a managing entity is listed but not one listed below, inform of ineligibility and give them the option that the person would have to switch plans or their address to a area we cover.)


  • AmeriHealth Caritas 
  • Blue Cross AND Blue Shield (Health Blue)
  • United Healthcare 
  • Well Care
  • Carolina Complete 
  • Partners 
  • Trillium 
  • Vaya


Example of Eligible Person 

Example of Eligible Person

Example of Eligible Person

Example of Eligible Person

Example of NOT Eligible Person

This person was eligible at one point but no longer have Medicaid 


There is typically a error message that informs to that the person is not eligible 


Example of NOT Eligible Person

Example of NOT Eligible Person




Was this article helpful?

That’s Great!

Thank you for your feedback

Sorry! We couldn't be helpful

Thank you for your feedback

Let us know how can we improve this article!

Select at least one of the reasons

Feedback sent

We appreciate your effort and will try to fix the article