skip to content
Thank you for visiting First Coast Service Options' Medicare provider website. This website is intended exclusively for Medicare providers and health care industry professionals to find the latest Medicare news and information affecting the provider community.
To enable us to present you with customized content that focuses on your area of interest, please select your preferences below:
Select which best describes you:
Select your location:
Select your line of business:
This website provides information and news about the Medicare program for health care professionals only. All communication and issues regarding your Medicare benefits are handled directly by Medicare and not through this website. Information for Medicare beneficiaries is only available on the medicare.gov website.
En Español
Text Size:
Send a link to this page
[Multiple email adresses must be separated by a semicolon.]
Last Modified: 3/15/2018 Location: FL, PR, USVI Business: Part A, Part B

‘SPOT eligibility reports’ FAQ

Q: How do I generate a SPOT eligibility report, and what information will be included?
A: SPOT users may access a beneficiary’s eligibility data for specific date(s) of service. This information is available through the ‘Check Eligibility’ tab at the top of the SPOT homepage or through the ‘Check Eligibility & Benefits’ window at the center of the home page. Each section of the report will focus on a different benefits category and will list the dates of service queried. You may save the report electronically or print a copy to place in the patient’s file for easy reference.
To generate a SPOT eligibility report, follow these steps:
1. Establish the parameters of your eligibility query. You have two options to submit your query to HIPAA Eligibility Transaction System (HETS):
a. You may submit a new query by entering a date of service range as well as the beneficiary’s Medicare number, last name, and either the first name or date of birth. Once you have entered the required information, you may click the Search button.
Note: You may limit your query to the date(s) the service will be furnished to the patient, or you may specify any time period up to four months in the future and 12 months in the past.
b. You may resubmit a previously submitted eligibility query (within the same session) by clicking the corresponding resubmit query link in the Eligibility & Benefits Inquiry: ‘Previous Queries’ table. (Note: This table will only display previously submitted queries in the same session.)
Eligibility and Benefits Inquiry
Note:
If you receive an error message after submitting an eligibility query, the message is generated from HETS. Check to make sure that you have no spaces before or after data entered in required fields. However, during high volume periods, HETS may return an error message erroneously, or your query may “time out” due to slower than normal response times.
2. Review the beneficiary’s eligibility profile based upon the dates of service specified in your query. Your results will include Medicare Part A and Part B eligibility status as well as all active data available from HETS at the time of your query, which may include Preventive Services, Deductibles/Caps, Inpatient, Hospice/Home Health, Medicare secondary payer (MSP), and Plan Coverage data categories.
3. Click the PDF icon (located on every results page), and SPOT will automatically export the data to a printer-friendly eligibility report in PDF format. Each section of the report will focus on a different benefits category and will list the dates of service queried.
4. You may save the report electronically or print a copy to place in the patient’s file for easy reference. To view a sample SPOT eligibility report, please click here pdf file.

‘SPOT eligibility report’: Data included

When a user submits an eligibility query through the SPOT, a direct connection is established with CMS’ HIPAA Eligibility Transaction System (HETS). HETS is the source of the eligibility data that is returned, and the portal application displays the information.
Each section of your SPOT eligibility report will focus on a different benefits category and will list the dates of service queried as well as the date the report was generated.
Eligibility
Your report will include the beneficiary’s personally identifiable information (PII), Medicare Part A and Part B eligibility status, and all active data available from HETS at the time your query was submitted, which may include:
Deductibles/Caps
Inpatient
Hospice/Home Health
Medicare secondary payer (MSP)
Plan Coverage
Qualified Medicare Beneficiary (QMB)
To view a sample SPOT eligibility report, please click here pdf file.
list item Please use your browser's back button to return to the referring page.
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.