130 CMR, § 450.107 - Eligible Members and the MassHealth Card
(A)
Eligibility
Determination. MassHealth eligibility is determined in accordance
with 130 CMR 501.000 through 130 CMR 522.000. Eligibility for the EAEDC Program
is determined pursuant to 106 CMR 320.000 through 321.000, 701.000 through
701.600,
705.000 through
705.950, and
706.000 through
706.710.
(B)
Eligibility Verification
System. The MassHealth agency uses the Eligibility Verification
System (EVS) for day-specific eligibility verification, and to communicate a
member's MassHealth eligibility, coverage type, managed care status,
restrictions, and other insurance information to health-care
providers.
(C)
MassHealth Card. The MassHealth agency issues a
plastic identification card for most MassHealth members. The MassHealth card
contains information necessary to access EVS. Members for whom the MassHealth
agency pays health insurance premiums only may not have a MassHealth
card.
(D)
Temporary
MassHealth Eligibility Card. When necessary, the MassHealth agency
or the Department of Transitional Assistance will issue a temporary MassHealth
card to the cardholder for use until a plastic MassHealth card is issued. The
temporary MassHealth card shows dates of eligibility, service restrictions, and
other insurance information. If a discrepancy occurs between information given
on a temporary MassHealth card and by EVS, the information on the temporary
card prevails. To be paid for a covered service that was provided based on
information given on a temporary card, a provider must produce a copy of the
temporary card, and have otherwise met all other prerequisites for
payment.
(E)
Provisional Eligibility. The MassHealth agency will
provide eligibility while the applicant provides to the MassHealth agency any
outstanding verification, in accordance with
130 CMR
502.003: Verification of Eligibility
Factors.
Notes
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