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My claim denied for eligibility reasons. How do I check 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 1.266.289.6501 and select Option 2. Refer to the Interactive Voice Response (IVR) System Jurisdiction 15 Part A 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 myCGS for additional information.

Fiscal Intermediary Standard System (FISS) Direct Data Entry (DDE) – The FISS DDE Inquiry Menu includes the Beneficiary/CWF (Option 10) allows access to beneficiary eligibility information. Learn more by accessing the DDE User Manual/FISS Reference Guide, Chapter Three: Inquiry Menu documentPDF. In addition, you can access the CMS eligibility systems ELGA/ELGH through your existing FISS connection. Refer to the DDE User Manual/FISS Reference Guide, Chapter Two: Checking Beneficiary EligibilityPDF document.

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