Part A IVR Operating Guide – Eligibility

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Part A IVR Operating Guide – Eligibility

Published on Feb 11 2020, Last Updated on Jun 16 2023

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Jurisdictions: J8A,J5A

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Touch-Tone Option	Vocal Option
1	“Eligibility”

To Use:

Say or enter the patient’s Medicare number.
Say or enter the patient’s first and last name as it appears on the Medicare card.
Say or enter the patient’s date of birth.
Say or enter the date of service to verify file information about Medicare Secondary Payers (MSP) and Health Maintenance Organizations (HMO). The date of service can be up to 4 years in the past or 4 months to the day in the future.
Say or enter “address” if you would like to hear the beneficiary’s address or say or enter “eligibility” to hear the eligibility information or say or enter “operator” if you already have the eligibility details and need assistance from an agent.

Eligibility Information Available:

Beneficiary’s address (if chose to hear)
Part A and B current effective dates and entitlement reason
Part B Immunosuppressant Drug (Part B – ID) current effective date coverage (if applicable)
Date of Death (if applicable)
QMB (Qualified Medicare Beneficiary) status (if applicable)
Part D data: company name, plan name, plan code, ID, address, phone number, website, effective and termination date(s) (if applicable)
Hospital full and coinsurance days (if applicable to provider type)
Skilled Nursing Facility full and coinsurance days (if applicable to provider type)
Lifetime Reserve days (if applicable to provider type)
Lifetime Psychiatric days (if applicable to provider type)
Hospital Stay date(s) and the billing NPI(s) (if applicable)
Skilled Nursing Facility Stay date(s) and the billing NPI(s) (if applicable)
Current year Physical Therapy (PT) and Occupational Therapy (OT) limits
Medicare Advantage (MA) details: Medicare Advantage company, plan name, ID, address, phone number, website, effective and termination date(s) (if applicable)
ESRD data: coverage start date, coverage end date, dialysis start date, dialysis end date, transplant date (if applicable)
Deductible information (current year)
Primary health insurance information (whether Medicare is primary or secondary) *
MSP Data: MSP indicator code and description, company name, address, effective and termination date(s), diagnosis code(s) associated to the MSP record, policy ID, Group Number, Last MSP maintenance date, patient relationship code and description, MSP source code and description (if applicable)
Home Health (HHEH) information: episode start date, episode end date, date of earliest billing, date of latest billing, provider’s NPI, contractor name, contractor number, patient status code and description, Notice of Admission (NOA) indicator and description (if applicable)
Hospice status and data: NPI, start and end date(s), revocation indicator, days used, earliest and latest billing date(s) for the current period
COVID vaccine data: eligibility for vaccine, vaccine administration code(s), date(s) given, NPI of rendering provider (if applicable)
Flu vaccine data: vaccine code, vaccine administration code, date(s) given, NPI of rendering provider (if applicable)
Medicare Diabetes Prevention Program (MDPP) data: usage, date of service(s), NPI(s), procedure code(s) (if applicable)
Preventative Services (if chose to hear)

*Please note, if a beneficiary is enrolled in an HMO, the IVR will state Medicare is primary and will indicate whether it is a risk-type HMO or cost-type HMO. If the HMO is a risk-type, providers may only bill the HMO. If the HMO is a cost-type, providers may bill the HMO or WPS Government Health Administrators. Please refer to the CMS Internet-Only Manual (IOM), Publication 100-04, Chapter 1 , for further details on claim submission.

After You Receive Eligibility Information, You Can:

Say, “Repeat that”
Say “Preventative Service”
- Provide a procedure code when the IVR asks “What procedure code would you like to hear about?”; the IVR will read back the next eligible date for the procedure code and repeat options available; you can repeat this until you have heard all the codes you wish to check
Say, “Address”
Say, “Operator” to speak to an agent
Say, “Change Date” to change the date of service
Say or enter another patient’s Medicare number when you hear the prompt, “Tell me another patient’s Medicare number”
Say, “Main Menu” to start over
Say, “Good-bye” if you are finished with the IVR

global-tags: J8A,J5A

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NPI_MODAL_PART_B_TITLE	NPI_MODAL_PART_A_TITLE
J5B RADIO NPI_MODAL_J5B_RADIO	J5A RADIO NPI_MODAL_J5A_RADIO
INB NPI_MODAL_INB_RADIO	NTA NPI_MODAL_NTA_RADIO
MIB NPI_MODAL_MIB_RADIO	INA NPI_MODAL_INA_RADIO
	MIA NPI_MODAL_MIA_RADIO

Part A IVR Operating Guide – Eligibility

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Part A IVR Operating Guide – Eligibility

global-tags: J8A,J5A