Options for Checking Beneficiary Eligibility
In an effort to protect Medicare beneficiaries from fraud, the Centers for Medicare & Medicaid Services (CMS) directed Medicare Administrative Contractors (MACs), including the RRB Specialty MAC, to disable access to beneficiary eligibility information in our Interactive Voice Response (IVR) systems.
Palmetto GBA disabled IVR beneficiary eligibility information in our IVRs on January 31, 2025, at 7 p.m. ET.
Providers and suppliers will need to verify beneficiary eligibility using the following online tools and services only:
- MAC secure online provider portals
- Billing agencies, clearinghouses, or software vendors
- Health Insurance Portability and Accountability Act (HIPAA) Eligibility Transaction System (HETS)
Use the Palmetto GBA Secure Online Portal, eServices
Providers who previously used the IVR for eligibility inquiries are strongly encouraged to use the Palmetto GBA secure online portal, eServices, instead.
In eServices, you can use the Eligibility lookup feature to quickly and easily obtain the beneficiary eligibility information that has been historically available on the IVR and more, including the following:
- Part A and Part B Eligibility Dates
- Part B Deductibles and Caps
- Preventive Services
- Medicare Advantage Plan and Medicare Part D Plan Coverage
- Medicare Secondary Payer Information
- Hospice and Home Health Information
- Part A Inpatient and SNF Information
- Qualified Medicare Beneficiary (QMB) Program Eligibility
If you are not already registered to use eServices for Palmetto GBA Railroad Medicare, we encourage you to register today on the eServices Portal. You can participate in eServices for Railroad Medicare if you have an electronic data interchange (EDI) Enrollment Agreement on file with Palmetto GBA Railroad Medicare. If you are already submitting claims electronically to Railroad Medicare, you do not have to submit a new EDI Enrollment Agreement.
If you are registered in eServices for Palmetto GBA Jurisdiction J or M, you will need to register a separate account for Railroad Medicare to access information for your Railroad Medicare patients and claims. This is because Railroad Medicare is a different jurisdiction. You will be assigned a different user ID for each line of business and each PTAN/NPI combination.
To access information for your Railroad Medicare patients, you must sign into eServices using your Railroad Medicare user ID or select that account from the drop-down menu if you have logged into a linked account for multiple jurisdictions. For instructions on linking multiple eServices accounts, see section 12.0 Account Linking in the eServices User Manual.
You can find complete instructions on registering for and using eServices in our eServices Portal resources.