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Elizabeth M. Whitehorn, Director

Recipient Eligibility Verification Program (REV)

Current REV Vendors

Public Act 88-554 mandated that the Department create a statewide electronic Recipient Eligibility Verification (REV) system. Thus, the REV system is available to enrolled providers throughout the state. The REV system utilizes various clearinghouses that relay electronic transactions back and forth between a provider and the Department. These clearinghouses, known as REV vendors, have direct telecommunication line access into Department databases. Each REV Vendor has developed a unique process of transmitting data to the providers. REV Vendors develop standardized software for providers to use on existing personal computers, point-of-service devices, and provide programming for existing computer systems to accept and transmit data.

Through the REV Program, the vendors provide information on eligibility including, but not limited to: Medicaid, All Kids and Medicare eligibility; HMO enrollment data and managed care information; recipient restriction status; and recipient health insurance coverage information. The REV system also allows providers the ability to: submit claims electronically; check claims status; check claims history; check on rejected claims; and download batches of claim information (status of claim, adjudicated figures, paid amounts, etc.). In addition, a transaction to allow durable medical equipment providers to submit prior approval requests is also available.

Long Term Care providers can use the REV system to electronically transmit bed reserve information, nursing home discharge information and Medicare payment status electronically to the Department.

All current REV vendors also act as clearinghouses for other public and private payers. In this role, REV vendors offer services beyond those related to the Department. Thus, REV vendors have the option to offer providers a variety of services in addition to the electronic transactions offered through the REV system, including but not limited to, general computer accounting support, technical assistance, claims submittal, preliminary claim editing, accounts receivable postings, and submitting claims to various third-party payers.

Providers wanting access to the REV system or other services, sign an agreement with one or more vendors and pay the REV vendors for whatever mix and volume of services they select.