Last Modified: 8/5/2019
Location: FL, PR, USVI
Business: Part A, Part B
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.
Part A providers
• 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
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.
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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.