PA/DVS Confirmation Request

Taxonomy Code: Enter the Taxonomy code of the provider who initially requested the DVS. The Requesting Provider is that which is currently logged into the ePACES system; validate the name displayed in the upper left hand corner of the page is the proper Provider. See the appropriate Taxonomy Code/Service Type combinations for NYS Providers and Out-of-State Providers.

Type of Service: Enter or select the code for the type of service rendered. See the appropriate Taxonomy Code/Service Type combinations for NYS Providers and Out-of-State Providers.

Service Date: The date for which the DVS was requested. The date may not be greater than the current date. The format for the date is: MM/DD/YYYY and may either be entered in the field or selected from the calendar available by pressing the button to the right of the field. The field will default to the current date.

If desired, quantity information from the original request may be entered but it is not required to successfully process the Confirmation.

Item Code: Select whether the value entered in the box is a Procedure Code or an NDC Code. Enter the code value in the text box below the radio buttons. If entering an NDC Code, you must enter the 11-digit code with no hyphens.

Qty Dispensed: Enter the quantity to be approved.

Dental HCPCS: Enter the HCPCS (Healthcare Common Procedure Coding System) procedure code which applies to this DVS Request. This value must start with the letter ”r;D”. It is not case sensitive.

Site Code: Enter the tooth number/code for the tooth related to this service. The value entered must appear in the pop up window list. This value is not required.

Times: Enter the quantity of service(s) related to the Site Code entered. Decimal values may be entered. If the HCPCS Code is entered this field is required.