Beneficiary Eligibility Information Not Offered on the IVR Beginning 11/18/2024
To help protect Medicare beneficiaries against fraud, CMS is instructing all MACs to remove beneficiary eligibility information from our IVR systems. Starting 11/18/2024, you won’t be able to obtain beneficiary eligibility information from our IVR.
This includes beneficiary eligibility that was obtained under Option 1, Eligibility, such as:
- Part A and Part B entitlement dates
- Current/prior year Part B deductible information
- Current/prior year physical therapy and occupational therapy limit amount used
- ESRD coverage dates, dialysis and/or transplant date
- HH+H name, NPI, address and effective/termination dates
- Preventive care details
You can use our free, secure internet portal, NGSConnex to obtain eligibility information for your patients. If you’re not enrolled in NGSConnex, use the instructions in the Registration section of the applicable NGSConnex User Guide below to start the enrollment process:
- NGSConnex User Guide for Part A, HH+H and FQHC providers
- NGSConnex User Guide for Part B providers
We’ve scheduled several webinars that will provide an overview of NGSConnex, including how to register, navigate and look up beneficiary eligibility within the portal. There will be time allotted after the overview to answer your questions. You may register below, or via our Events page.
The webinars below are held in eastern time.
NGSConnex: Overview, Access, Navigation and Eligibility Look Up
| Date | Time | Link to Register |
|---|---|---|
| Tuesday, 10/22/2024 | 10:00-11:00 a.m. | Register |
| Thursday, 10/24/2024 | 10:00-11:00 a.m. | Register |
| Monday, 10/28/2024 | 9:00-10:00 a.m. | Register |
| Wednesday, 10/30/2024 | 8:00-9:00 a.m. | Register |
| Monday, 11/4/2024 | 11:00 a.m.-12:00p.m. | Register |
| Tuesday, 11/5/2024 | 2:30-3:30 p.m. | Register |
| Monday, 11/11/2024 | 9:00-10:00 a.m. | Register |
| Thursday, 11/14/2024 | 2:00-3:00 p.m. | Register |
| Monday, 11/18/2024 | 11:00 a.m.-12:00 p.m. | Register |
| Wednesday, 11/20/2024 | 9:30-10:30 a.m. | Register |
| Tuesday, 11/26/2024 | 10:00-11:00 a.m. | Register |
| Monday, 12/2/2024 | 11:00 a.m.-12:00 p.m. | Register |
The HETS is another tool that some providers utilize. HETS provides access to Medicare beneficiary eligibility data to providers, clearinghouses, and/or third-party vendors through the HETS 270/271 application. Please visit the HIPAA Eligibility Transaction System (HETS) page on CMS’s website for more information including how to get set up with HETS, companion documents, examples, and FAQs.
Please don’t call our PCC to request beneficiary eligibility information as our CSRs aren’t permitted to share information that can be obtained through self-service.
Posted 10/11/2024