Last Modified: 5/1/2018 Location: FL, PR, USVI Business: Part A, Part B
Beneficiary eligibility and claim status FAQ
Medicare beneficiary numbers are changing in 2018
The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, requires CMS to remove Social Security Numbers (SSNs) from all Medicare cards by April 2019. A new Medicare Beneficiary Identifier (MBI) will replace the SSN-based Medicare number on new Medicare cards starting in 2018 for Medicare transactions like billing, eligibility status, and claim status. Find more details here.
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 his/her legal representative.
Eligibility information through SPOT
First Coast Service Options Inc. offers such access through SPOT (Secure Provider Online Tool). 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) 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 -- this is also a real time inquiry, and you can obtain the eligibility information in a batch format for a number of 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 the Centers for Medicare & Medicaid Services (CMS), to refer you to the IVR. The IVR can access information up to 27 months from the date of the inquiry.
Source: CMS internet-only manual (IOM) publication 100-09, chapter 6, section 50.1
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