General

1. What information do I need to have available to obtain beneficiary entitlement?
2. HIQA indicates that our patient is enrolled in an HMO and the record indicates the coverage is an option 1. Where do we submit claims for this patient?

1. What information do I need to have available to obtain beneficiary entitlement?

   Providers need to have the following information available when calling the IVR to obtain a patient's Medicare entitlement

   1) Provider number
   2) Patient's correct HIC number
   3) Patient's correct last name & first initial
   4) Patient's correct date of birth
   5) Date of service (note: this cannot be a date in the future)

   For your convenience we have an "IVR Name To Number Conversion" tool that was created to assist providers who prefer to key the beneficiary's name rather than speak it. Simply type the beneficiary's name, press the convert button and the name will be converted to the number that is required by the IVR. The numbers to call the IVR for PA is 1-800-560-6170 and for MD/DC call 1-866-488-0545.  Also, there is a quick reference guide for using the IVR  for MD/DC providers, and for PA providers. 

   Date Posted: 03/17/2008, Date Reviewed/Revised: 07/28/2008

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2. HIQA indicates that our patient is enrolled in an HMO and the record indicates the coverage is an option 1. Where do we submit claims for this patient?

   Option 1 on an HMO record means that it is an unrestricted HMO.  All of the patient's claims are processed by the intermediary.

   (Question based on May 2008 top written inquiries)

   Date Posted: 07/28/2008

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