Check the member’s eligibility and benefits prior to rendering services. This helps ensure that you submit the claim to the correct payer, collect copayments, determine if a referral and prior authorization or notification is required and reduces denials for non-coverage.
There are three easy ways to verify eligibility and benefits:
- EDI: Transactions 270 (Inquiry) and 271 (Response) through your vendor or clearinghouse
- Online: eligibilityLink
- Phone: 877-842-3210
We can provide you with daily member eligibility information using an electronic 834 file containing eligibility changes. We can provide a full eligibility file monthly. You must coordinate initiation of electronic eligibility files with your software vendor and us. Some of the advantages of receiving electronic eligibility are:
- An eligibility upload may reduce your costs by reducing the effort required to maintain eligibility manually.
- Eligibility updates can be loaded into your system in a timely manner.
Refer to the section titled ASC X12 Technical Report Type 3/ Companion Guides for more information, or ask your provider advocate.