Automated Voice Response Eligibility Verification Subsystem Call Flow Manual
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USER ACCESSThis section of the manual gives instructions and information on how to access the Customer Service Voice Response System by explaining the security, listing telephone numbers and directing you where to go for assistance if necessary. SECURITYA valid Kentucky Medicaid Provider Number is required to access the Automated Voice Response Eligibility Verification (AVREV) system. Only data as authorized in the State Medicaid Manual, Part II, will be reflected in the Automated Voice Response Eligibility Verification (AVREV) response. The Eligibility Verification information will be given only as a direct result of a provider inquiry on a specific member. Kentucky Medicaid personnel have a special access number to use to access the system. Only authorized staff has access to this number. Any transaction made with the Kentucky Medicaid special access number can be excluded from reporting statistics as necessary. Telephone NumbersThe Automated Voice Response Eligibility Verification (AVREV) system allows providers to use a touch-tone telephone to access Member eligibility, Check Write and Claims Status data. The toll-free number for in-state providers currently is: 1-800-807-1301 The non toll-free number for out-of-state providers currently is: 502-226-1140 Providers who do not have access to a touch-tone phone will have the option of being automatically switched to a Customer Service Representative. Personnel are trained on information applicable to the requested transaction using the Kentucky Legacy MMIS on-line files.
User AssistanceYou can contact a Customer Service Representative by currently calling the following number: 502-226-1140 The Customer Service Representatives are trained to handle individual inquiries and assist providers with various (including, but not limited to, billing, claims, etc.) questions.
DISCONNECTINGAt any time a user may disconnect from the system. There are three ways to do this. The first is to simply hang up the phone. The second is to press *9 pound key (*9#) from any menu choice or the third is to press *9 pound key(*9#) from any data entry point. The system will play the following message and the system disconnects the line: “Thank you for calling the Kentucky Automated Voice Response Eligibility Verification System. Goodbye.” Call Flow IntroductionThis section describes how the system speaks the information based on the user requests, presents a call flow diagram of the inquiry session, and presents the call flow narrative. The text that is indented and in bold type is a vocabulary description that represents the actual speech the voice response system uses to communicate with the user. Speech VariablesA parenthesized reference within a vocabulary description indicates that the Automated Voice Response System translates the data into speech and speaks it to the user. This method is used to represent components of a response that change based on variable data. The following system response is used as an example: "Invalid provider number (525) (VRS-PROVIDER-NO). Please re-enter." (521) The notation (VRS-PROVIDER-NO) represents a data variable containing a provider number that the system speaks to the user.
Speech CharacteristicsThe Automated Voice Response System must translate the data contained in variable data fields into speech for the user. There are several types of data the system must translate: character values, numeric (numbers or monetary amounts) values, and dates. When the system encounters a character field, it speaks the value in the field one character at a time. For example, if the data variable called NAME contains the characters "John Doe", the system speaks each letter of the name so the user hears: "J-O-H-N pause D-O-E" For numeric fields such as the Social Security number, the system speaks the values one digit at a time. For example, the system would speak the Social Security number 123-45-6789 as follows: "one-two-three-four-five-six-seven-eight-nine" If the numeric field represents a dollar value, the system speaks the value as a monetary amount. For example, the system speaks the amount "$18,562.14" as: "eighteen thousand five hundred sixty two dollars and fourteen cents." The Automated Voice Response System speaks the value in a date field as a Gregorian date. For example, the date 06/30/1989 is spoken as: "June thirtieth nineteen eighty-nine."
VOICE MEMBER ELGIBILITY VERIFICATION SYSTEMSection 1 - Menu OptionsSTEP 0.0 - WelcomeWhen a user calls a Kentucky Medicaid Automated Voice Response System telephone number, the Automated Voice Response System answers the phone and issues the following welcome message: “[Good Morning, Good Afternoon, Good Evening] Welcome to the Kentucky Voice Response Eligibility Verification System. The information given is subject to change without notice. Please verify the Kentucky Medicaid Member Card. Please select one of the following options, followed by the pound sign. For Eligibility Verification, KenPAC, Third Party Liability, Service Provider Check Write, Lock-in, Claim Status, Managed Care, Prior Authorization or PRO Review Information, Card Issuance or Co-Pay information, press 1. For an explanation of special automated voice response system features, press 2. If you have submitted your enrollment application within the last 30 days, your application is still in process. If you need further assistance, please call the Provider Enrollment call center at 877-838-5085. For assistance from a Customer Service Representative, press 0.” The system ensures that the user enters a valid option. If the user enters any other response, the system responds with the following message: “Invalid option. Please re-enter.” If the user presses 1, the system continues the call flow at Step 1.0. If the user presses 2, the system will respond with the following messages: “The AVRS uses 2 special function keys - the pound sign and the asterisk or star keys. The pound sign key must always be used at the end of any touch-tone keypad entry. For example, if you are prompted to enter your user id of 1234567, you must enter 1234567 and the pound sign on the touch-tone keypad.” “If you wish to have the system repeat the last inquiry response, press the asterisk key once and then the pound sign. If you wish to have the system repeat the last prompt, press the asterisk key twice and then the pound sign. If you wish to return to the Main Menu, press star 99 and the pound sign at any prompt.” After the caller hears an explanation of special automated voice response system features, the call is taken back to Welcome menu at Step 0.0. If the user enters an invalid option, the system will respond with the following message: “Please hold for a Customer Service Representative.” On the first time-out, the system assumes the call is using a rotary telephone, so the system attempts to transfer the call to a Customer Service Representative. See the Global Messages and Events section for the call transfer process.
STEP 1.0 – Authorized To AccessTo determine whether or not the user is authorized to access Medicaid information, the system checks the user’s Kentucky Medicaid Provider Number. If the provider number is on file and has the appropriate enrollment status, the user is authorized. The system prompts the user to enter a provider number as follows: “Please enter your eight-digit or ten-digit Medicaid Provider ID number followed by the pound sign.” If the user enters a provider number, the system performs an edit to ensure that it is a valid format. If the provider number fails this edit, the system prompts the user for a provider number with the following message: “Invalid provider number (PROVIDER-NUMBER). Please re-enter.” After the user enters a provider number in the correct format, the system sends a transaction to the host to verify that the user’s provider number is on the Provider Master file. In some cases, there may be a slight delay while the system waits for the information to return from the host, so the system informs the user with the message: “Please wait while the requested information is retrieved.” If the provider is validated, the system continues the call flow at Step 2.0 with Menus for Provider. On the first attempt if the provider number is not validated, the system informs the user: “We’re sorry, provider number (PROVIDER NUMBER) is not on file. Please re-enter.” On the second attempt, if the provider number is not validated, the system informs the user and speaks the following message if it is during normal business hours of 7 am to 6 pm ET, Monday through Friday. “We’re sorry, provider number (PROVIDER–NUMBER) is not on file. Please hold for a Customer Service Representative.” – or – “We’re sorry, provider number (PROVIDER–NUMBER) is not on file. For assistance from a Customer Service Representative, please call back between 7:00 AM to 6:00 PM, except weekends and holidays, and we’ll be happy to assist you. Thank you for calling the Kentucky Automated Voice Response System.” STEP 2.0 – Menus For Provider With/Without Service LimitationsThe system has verified the user’s authorization and now presents the users with a transaction menu. “Please select one of the following options followed by the pound sign.” “For Eligibility Verification, press 1. For KenPAC, TPL, Lockin, Service Limitations, Managed Care or Co-Pay information, press 2. For Provider Check Write, press 4. For Claim Status, press 5. For Prior Authorization or PRO Review Information, press 6. For Card Issuance information press 7. For assistance from a Customer Service Representative, press 0.” If the user presses 1 for Member Eligibility inquiry, the system continues the call flow at Step 3.0. If the user presses 2 for KenPAC, Third party Liability, Lockin, Service Limitations, Managed Care or Co-Pay information, the system continues the call flow at Step 2.0.A. If the user presses 4 for the Provider Check write, the system continues the call flow at Step 26.0. If the user presses 5 for Claim Status, the system continues the call flow at Step 27.0. If the user presses 6 for Prior Authorization or PRO Review information, the system continues the call flow at Step 2.0.B. Finally, if the user presses 0 for assistance, the system transfers the call to a Customer Service Representative.
STEP 2.0.A – KenPac, TPL, Lockin, Service Limitation, Co-pay, and Managed care InformationIf the user presses 2 from the Main Menu, the system prompts: “Please select one of the following options followed by the pound sign.” “For KenPac information, press 2. For TPL information, press 3. For Co-Pay information, press 4. For Managed Care information, press 5. For Lockin verification, press 6. For Service Limitations, press 8. If the user presses 2 for KenPAC inquiry, the system continues the call flow at Step 13.0. If the user presses 3 for Third Party Liability inquiry, the system continues the call flow at Step 18.0. If the user presses 4 for Co-Pay inquiry, the system continues the call flow at Step 65.0. If the user presses 5 for Managed Care inquiry, the system continues the call flow at Step 55.0. If the user presses 6 for Lock-in inquiry, the system continues the call flow at Step 38.0. If the user presses 8 for Service Limitations inquiry, the system continues the call flow at Step 43.0.
STEP 2.0.B – Prior Authorization InformationIf the user presses 6 from the Main Menu, the system prompts: “Please select one of the following options followed by the pound sign.” “To check the number of stay days using a member number and PA Number, press 1. To check the status of a PA using a rendering provider number, member number and date of service, press 2.” If the user presses 1 for stay days inquiry, the system continues the call flow at Step 50.0. If the user presses 2 for PA status inquiry, the system continues the call flow at Step 70.0.
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