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How do I access eligibility information for a Medicare patient?

Providers are required to use self-service technology, such as the Interactive Voice Response (IVR) system or the myCGS web portal to access claim status and beneficiary eligibility information. Customer Service Representatives (CSRs) will refer providers to these resources when calling for claims status or eligibility information. Exceptions will be made if your experience technical difficulties.

Interactive Voice Response (IVR) – Use the IVR to check the eligibility of a Medicare beneficiary by calling 1.877.220.6289 and select Option 2. Refer to the Interactive Voice Response (IVR) System Home Health & Hospice User GuidePDF for additional information. Use the Medicare Beneficiary Identifier (MBI) and Name to Number Converter self-service option. This tool converts letters to numbers for easy entry using your telephone keypad.

myCGS Web Portal – myCGS also provides eligibility information. Refer to the myCGS User Manual, Chapter 4: Eligibility TabPDF for detailed instructions. If you are not registered to access myCGS, refer to the Chapter 1: Overview of myCGSPDF for additional information.

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