Eligibility Inquiry Service

An Medicare eligibility and benefits inquiry should be completed for every patient at every visit to confirm membership, verify coverage and determine other important information, such as the patient's co-pay, co-insurance and deductible amounts.

CMS offers an X12 270/271 Eligibility System (HETS 270/271). The HIPAA Eligibility Transaction System (HETS) is intended to allow the release of eligibility data to Medicare Providers, Suppliers, or their authorized billing agents for the purpose of preparing an accurate Medicare claim, determining Beneficiary liability or determining eligibility for specific services. The Eligibility Benefit Inquiry application is developed using the CMS HIPAA Eligibility Transaction System (HETS) and it allows real-time access to patient Medicare Eligibility information, including coverage dates, benefit ceilings, co-pays, deductible and more.One of the most common reasons for claim rejection or denial is ineligibility.Rather than putting reimbursement at risk after a patient encounter, you can use our real-time eligibility solutions to determine patient insurance eligibility prior to rendering service.

Eligibility and benefits inquiries may be completed online easily and efficiently using the following Eligibility and Benefits Inquiry applications.

With these applications, you’ll be able to:
  • Receive real-time access to critical patient and insurance information, including coverage dates, benefit ceilings, co-pays and more
  • Reduce costly rejections and denials by checking eligibility before patients are seen
  • ncrease profitability – reduce costly write-offs
  • Improve productivity – eliminate manual eligibility verification and one website to access multiple payers
  • Increase cash collections – obtain up-to-date co-pay, co-insurance and deductible information