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Last Modified: 2/24/2011
Location: FL, PR, USVI
Business: Part A
Health maintenance organization (HMO) record inquiry
Do you frequently contact our provider customer service lines requesting information on HMOs? Are you asking whether the beneficiary is enrolled in an HMO, when HMO enrollment began, or for HMO contact information?
If you answered 'yes' to these questions, you can find this information by using one of the two methods below.
• Direct data entry (DDE) 
users may obtain HMO information via the ELGA (eligibility A) or HIQA (health insurance query Part A) screens.
users may obtain HMO information via the ELGA (eligibility A) or HIQA (health insurance query Part A) screens.• The information can be located on page one of the eligibility screen at the bottom of the page.
• Plan-Type -- Type of HMO
• CURR-ID -- HMO ID code assigned by the Centers for Medicare & Medicaid Services (CMS)
• OPT -- One digit code that describes the beneficiary’s relationship with the HMO, and who is responsible for processing the beneficiary’s claim.
• ENR -- HMO enrollment date/HMO benefits effective date
• TERM -- HMO termination date
• Contact the interactive voice response (IVR) (replaced link to point to quick reference guide, due to 2 IVR operating guides now) system.
(replaced link to point to quick reference guide, due to 2 IVR operating guides now) system.
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Source: FCSO Education Action Team
