CMS Releases Fact Sheet on Medicare Eligibility

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The Centers for Medicare & Medicaid Services (CMS) has released a fact sheet to help providers determine if their patients are eligible for Medicare.

For example, the CMS advises providers to check for eligibility for Medicare-covered supplies and services and regularly review their patients’ eligibility information. Patients may be eligible for Medicare if they are age 65 or older, under 65 with certain disabilities, or of any age and have end-stage renal disease.

Providers can check for eligibility through the Medicare Administrative Contractor (MAC) Portal, MAC Interactive Voice Response (IVR) System, HIPAA Eligibility Transaction System (HETS), and billing agencies, clearinghouses, or software vendors.

Each MAC offers its own Medicare online provider portal where providers can access real-time information anytime. Eligibility information can be found by searching by Medicare Beneficiary Identifier (MBI), first and last name, or date of birth. Providers should contact their MAC to use the appropriate portal.

Also, each MAC offers its own Medicare IVR so providers can access real-time information anytime as well. Authentication is available by entering a National Provider Identifier, a Provider Transaction Access Number, or the last five digits of a Tax Identification Number. Eligibility information can be found via MBI, first and last name, and date of birth.

Four years of eligibility data additionally can be accessed in HETS in real time. MBI, first and last name, and date of birth are needed to check eligibility. Further, the fact sheet links to a list of available billing agency, clearinghouse, and software vendors that provide services.

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