Coming Soon: Beneficiary Eligibility Information Will Be Unavailable in the Interactive Voice Response System

Published 12/18/2024

In an effort to protect Medicare beneficiaries from fraud, the Centers for Medicare & Medicaid Services (CMS) has 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 will disable IVR beneficiary eligibility information on January 31, 2025, at 7 p.m. ET.

After the IVR systems are disabled, 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 are currently using 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 the resources on our eServices Portal.  

Join Us for Upcoming Education

We will be holding several webinars in January 2025 focused on how to register for and use the eServices portal to check patient eligibility. Details of the webinars will be posted to our Events and Education page. Please plan to join us on one of the events.

Follow our Email Updates for more information on this topic as it becomes available. You can use the following link to register to receive Railroad Medicare email updates.

Resources


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