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Last Modified: 7/13/2022 Location: FL, PR, USVI Business: Part A, Part B

Beneficiary eligibility and claim status FAQ

Q: How do I obtain beneficiary eligibility information and/or claim status?
A: To access the status of a claim or a beneficiary's Medicare eligibility information (including the date of birth, date of death, entitlement dates, benefit dates, deductible, or coinsurance) use these options below.
Prior to providing services, obtain a copy of the beneficiary's Medicare card and verify the beneficiary's insurance information with either the beneficiary or their legal representative.

Eligibility information through SPOT

First Coast offers such access through SPOT. With SPOT, providers may access Part A and Part B eligibility status as well as benefit eligibility for preventive services, deductibles, therapy caps, inpatient, hospice and home health, Medicare secondary payer (MSP), plan coverage data categories and claim status up to twelve months from the date of the inquiry.

Other options for determining beneficiary eligibility

Part A providers
Contact the Part A interactive voice response (IVR) system at 877-602-8816.
Direct data entry (DDE) pdf file users -- by using the ELGA (eligibility A) screen, you can obtain eligibility information on any beneficiary for whom you are submitting claims.
270/271 eligibility transactions external link -- this is also a real time inquiry, and you can obtain the eligibility information in a batch format for several beneficiaries.
Part B providers
Contact the Part B IVR at 877-847-4992.
Note: Customer service representatives cannot assist you with eligibility information and are required, by CMS, to refer you to the IVR. The IVR can access information up to 27 months from the date of the inquiry.
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.