How to check medicare eligibility online for providers

By David MacQueen

Here at Episode Alert, we strive to make our services as simple and efficient as possible for our customers. We not only want each individual to feel comfortable using our system, but we also believe that it is our duty to help them understand our services and not only how to run a Medicare eligibility check through CMS's HETS (HIPAA eligibility transaction system), but also what they might need to look for in the report to ensure they get payment from there claims. No longer spend hours calling the IVR (interactive voice response).

Let’s start at the beginning. You have just arrived at work and need to start running patient/beneficiaries Medicare eligibility.

Where to begin

Let's start at the beginning. You have just arrived at work and need to start checking Medicare eligibility for a patient.

First, go to the Episode Alert website and click sign-in (a great idea would be to bookmark the sign-in page to make things easier for yourself)

Episode Alert sign in page

Once you are signed in you are greeted with the Eligibility summary log of your previous patients you have checked. Now if the patient you are working on has already been checked by our system in the past you can use the search bar to find them quickly and then use the check again button to save you time.

Medicare summary log of patients

This summary log is where you can quickly view all of the important information for that patient/beneficiary pulled from the CMS HETS system. This log will make life a lot easier and your eyes will thank you for not having to read through every patient's full report, detail by detail. Whenever you see either a green A (active) or a green checkmark you will know there are no issues

Medicare summary log of patients with a arrow to recent one

If you happen to see the red exclamation mark you can quickly know there may be a potential issue. What you can do is simply mouse over that red mark and it will give you some details to help you better understand what the issue is.

You can also always click on the PDF report which will give you all of the information that CMS provided.

Batch Mode

Now you may ask yourself “I have dozens or even hundreds of beneficiaries to check, is there an easier way”?

The answer is absolutely or services include access to our Batchmode checker. In these cases what you want to do is click on the Batch mode button. This will allow you to run large batches of patients at once. The batch mode summary log will give you a summary log of all your previous run batches, you will need to click “start a new Batch”

Medicare summary log of patients with a box around batch mode

From here you will see the format of the left in which you need to copy and paste the information in the box, once that is down you hit “check patient's eligibility” and sit back and let us do the work for you.

Medicare batch mode format needed

You will see on the batch mode summary log once a batch has been completed checking medicare eligibility information you simply need to click the view results button and you will be able to see all of the patients that have been run in that batch.

Medicare summary log of patients with a arrow to view results

Useful tips for Home Health agencies

When viewing the PDF report or the summary log as a home health agency you will want to check the following to prevent claim rejections:

  • Part A and Part B Active coverage

  • No active HMO

  • Make sure the are no overlapping PPS periods

  • MSP info does not overlap with your patient care dates and if it does the type of insurance should not be related to your care (ex: taking care of the patient after a car accident and the MSP is auto insurance)

  • Review Part A/B Benefits & Deductibles

If you are a Durable medical equipment provider or DME/HME then you need to look at the following closely

A DME/HME provider can sometimes forget how important checking Medicare coverage is.

  1. Must not have an active PPO

  2. Part A and Part B Active

  3. Make sure Part D is not active

  4. Review Part B Benefits & Deductibles

Hospices will be checking the same as Home Health agencies, the only difference will be they must check:

They need to take a close look at the hospice section of the eligibility information section for any overlap coverage to prevent claim rejections.

Thank you all for taking the time to join us and we hope this has given you some great insights into Medicare checks. You can try our no-contract 14-day trial

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