02/17/2020

How to check medicare eligibility online for providers


Welcome to our How-to series, this weeks topic we will cover “how to check Medicare eligibility online for providers”


Here at Episode Alert, we strive to make things as simple and efficient 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 not only how to run a Medicare eligibility check, but also what they might need to look for in the report


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


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

You will be returned to the summary log where your most recent patient will appear at the top. This summary log is where you can quickly view all of the important information for that patient/beneficiary. 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.


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

The answer is absolutely. 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. From the batch mode summary log which will give you a summary log of all your previous ran 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 completed and 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 he summary log as a home health agencies you will want to check the following:

  • Part A and Part B Active

  • 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 patient after 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

  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:

The need to take a close look at the hospice section for any over lap.


Thank you all for taking the time to join us for our “How to series” and we hope this has given you some great insights into Medicare checks. Stay tuned for more


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