Why am I missing eligibility information?
Palmetto GBA's eServices uses the CMS HIPAA Eligibility Transaction System (HETS) 270/271 system, which is designed to give you general eligibility checks for claims submission. Only the information that is available through HETS will be displayed in eServices. Crossover information is currently not available in HETS, and users will need to call the appropriate IVR for this information. Only HCPCS codes for which a particular beneficiary is eligible will be displayed on the preventive tab. If one of the preventive services has been rendered, it is removed from the list until closer to the time the beneficiary is eligible to receive the service again.
You may not be seeing information in the eligibility tabs because you are not entering a date range on the inquiry screen. To make sure you see all of the information, enter a date range in the inquiry screen. Please ensure that your entered date range includes a date after the beneficiary's entitlement date and before their date of death and/or the policy's termination date. The HETS 270/271 system we are required to access for eligibility allows date requests up to four (4) years prior to, and four (4) months in the future of, the current date. Date ranges may not exceed 12 months at a time.
If you are not seeing information on the Deductibles/Caps and Inpatient sub-tabs, the beneficiary may be enrolled in the Qualified Medicare Beneficiary (QMB) program. Beneficiaries who are enrolled in the QMB program are dually eligible for both Medicare and Medicaid. Please access the QMB sub-tab to view deductible information for these beneficiaries.
Please reference section 6 of the eServices User Manual (PDF, 8.21 MB) for screenshots and additional information on the eServices eligibility function.