Last Modified: 3/1/2020
Location: FL, PR, USVI
Business: Part A, Part B
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 ‘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 24 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.)
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
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
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.
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:
• Hospice/Home Health
• Medicare secondary payer (MSP)
• Plan Coverage
• Qualified Medicare Beneficiary (QMB)
To view a sample SPOT eligibility report
, please click here
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