Corporate

February 6, 2018

Checking Beneficiary Eligibility Using the Common Working File Queries

Change Request (CR) 10098External PDF, and the corresponding MM10098External PDF article were issued to inform providers that effective January 1, 2018, the CWF Provider Queries, ELGA, ELGH, HIQA, HIQH, and HUQA will only accept the National Provider Identifier (NPI) as a valid Provider Number. The Provider Transaction Access Number (PTAN) is no longer used to access eligibility information.

Below is a screen example of the ELGH eligibility screen (The ELGA entry screen is identical).

Screenshot

To check beneficiary eligibility using ELGA or ELGH, enter the following information:

Field Name What to Enter
HIC / MBI Number The beneficiary's Health Insurance Claim (HIC) number or their Medicare Beneficiary Identifier (MBI) number. NOTE: Beginning April 2018 through the end of the New Medicare Card transition period, you can submit either a HIC or MBI in ELGA/ELGH. Beginning January 1, 2020, the MBI must be used to access eligibility information. Refer to the CMS New Medicare cardsExternal Website website for additional information.
SURNAME The beneficiary's last name (six position field) If the beneficiary's name is John Smith Jr., enter "SMITHJ"
INITIAL The first letter of the beneficiary's first name.
DATE OF BIRTH The beneficiary's date of birth in a MMDDCCYY format
SEX CODE The beneficiary's gender (M or F).
REQUESTOR ID The requestor ID number 0011
INTER NO The Medicare intermediary number
  • 15201 for J15 Ohio providers
  • 15101 for J15 Kentucky providers
  • 15004 for J15 home health and hospice providers
NPI NO The facility's National Provider Identifier (NPI)
HOST ID Leave blank or enter one of the host IDs shown
APP DATE Leave blank or enter the date of admission to your facility.

For additional information about ELGA/ELGH, refer to the following resource.


Two Vantage Way, Nashville, TN 37228 © CGS Administrators, LLC. All Rights Reserved