How do I obtain beneficiary eligibility information and/or claim status?

Member for

6 months
Submitted by Charles.Johnson on

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. 

How can I ensure the beneficiary identification information submitted on my claim matches information on file for the patient?

Member for

6 months
Submitted by Bradley.Bohner on

It is crucial that beneficiary identification information submitted on claims is identical to the information found on the beneficiary's most recent Medicare card. Make a copy of the Medicare card for your records. 

  • If you are a laboratory, radiology department, or other entity to which the patient or their service(s) may have been referred, obtain a copy of the patient's Medicare card from the referring source prior to submitting your claim and verify the information indicated below.

What do I report in Item 32 (service facility location information) of the CMS-1500 paper claim form?

Member for

6 months
Submitted by Bradley.Bohner on

For services payable under the Medicare Physician Fee Schedule (MPFS) and anesthesia services, report the name and complete address (including ZIP code) of the physical location where services were rendered in Item 32. This information needs to be completed for all paper claims submitted to Medicare. Report a nine-digit ZIP code (instead of five digits) if the physical location is in an affected locality, as identified in the CMS IOM Pub. 100-04 Medicare Claims Processing Manual, chapter 1, section 10.1.1- 10.1.1.1. 

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