Recipient Medicaid ID Guide for EVV Providers

New Recipient Medicaid ID Rules (After July 1, 2024)

With the launch of the new Sandata electronic visit verifications system in July 2024, Ohio Department of Medicaid has been working to strengthen the integrity of the program, ensuring all data entries are accurate and complete. In support of this, Sandata now requires providers and vendors to enter Medicaid IDs and dates of birth when creating a recipient in the system.  This step is in an effort to avoid typos when manually entering information. Exceptions to this requirement are newborns without a Medicaid ID and ODA enrolled state-funded PASSPORT recipients.

How Providers Manage Recipient Medicaid IDs

Providers must create and manage recipient records in the Sandata EVV system. To add a new recipient, use the Create Recipient button and enter the Medicaid ID, date of birth (DOB), payer, and program. Sandata EVV then checks Ohio’s recipient eligibility system to make sure a match is found. Recipient demographics are returned when a match is found, and the provider can continue setting up their recipient.

Some providers use third-party vendors (Alternate EVV). These vendors send Medicaid ID information to the Sandata Aggregator, which is also checked against Ohio’s eligibility system.

What to Do if a Recipient Medicaid ID Changes or is Wrong

If a Medicaid ID is wrong or changes, providers must use the following steps based on the EVV system they use:

Sandata EVV

• Click the "Create Recipient" button and enter the new Medicaid ID with the recipient’s DOB. If visits were incorrectly recorded under the old recipient Medicaid ID the provider will be informed that the recipient is not found and will need to double check the recipient eligibility details with the Ohio Medicaid payer claims will be submitted to. All providers can contact the ODM Integrated Help Desk: 800-686-1516.

Alternate EVV (Third-Party Vendor)

• The provider should work with their vendor to send a new recipient record to Sandata with the DOB and updated Medicaid ID. The record submitted by the Alternate EVV vendor must have a new PatientOtherId value.
• If past visits were incorrectly recorded under the old recipient Medicaid ID, the provider must update the historical visit records with the correct Medicaid ID and PatientOtherId and send to the Sandata Aggregator.

Key Points to Remember

• Since July 1, 2024, Medicaid IDs for all new recipients are checked for accuracy before being added. The Medicaid ID and DOB must match an eligible recipient in Ohio’s eligibility system. Exceptions to this requirement are newborns without a Medicaid ID and ODA enrolled state-funded PASSPORT recipients.
• If a Medicaid ID changes or an existing recipient in Sandata EVV has an incorrect Medicaid ID, a new recipient record must be created in Sandata’s EVV system.
• If a Medicaid ID changes or an existing recipient sent via Alternate EVV has an incorrect Medicaid ID, the providers using an Alternate EVV system must send a new recipient record with the updated Medicaid ID when a change happens.
• If past visits have the wrong Medicaid ID, they must be fixed either by Sandata (for Sandata EVV users) or by the providers using an Alternate EVV system.   

Following these steps will help providers stay compliant with Ohio Medicaid rules and make sure records are correct, leading to successful claims matching. Claims that do not match will be denied and will not be paid.