Checking Beneficiary Eligibility
To ensure the accuracy and appropriate billing of Medicare covered home health and hospice services, the first vital step is to check a beneficiary's eligibility. Providers should also periodically review the beneficiary's eligibility information, as long as the patient is receiving services from your agency.
A Medicare beneficiary's eligibility should be checked, at a minimum:
To check Medicare eligibility, you must have the following beneficiary information:
Systems for Checking Medicare Eligibility
The following provides information about the systems available to CGS home health and hospice providers to check a beneficiary's eligibility.
myCGS – A CGS web portal that provides eligibility information based on the HIPAA 270/271 transaction.
CGS IVR (Interactive Voice Response) – A CGS telephone-based system that provides eligibility information based on the Common Working File (CWF).
HETS (HIPAA Eligibility Transaction System) – A Centers for Medicare & Medicaid Services (CMS) system, based on the HIPAA 270/271 transaction.
ELGA and ELGH – CMS eligibility systems that provide eligibility information based on the Common Working File (CWF).
NOTE:The Medicare Learning Network (MLN) Matters® article SE1249 was revised on February 10, 2014, indicating that provider access to ELGA/ELGH, which was originally schedule to be terminated April 7, 2014, has been delayed. CMS will provide at least 90 days advanced notice of the new termination date. CMS is in the process of updating HETS to return Hospice period information in the same format as ELGA/ELGH. Providers should prepare for this by establishing one of the alternative systems listed above for checking eligibility.
Information Available from Medicare Eligibility Systems
All systems will display basic information, including:
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