tci General Surgery Coding Alert - 2020 Issue Q4

Reader Questions: Know Data Elements for Eligibility

Question: We’re trying to verify a Medicare beneficiary’s eligibility with our MAC using an electronic claim form, and we’re having trouble. What elements are required to accomplish the verification? Florida Subscriber Answer: To verify your patient’s Medicare eligibility using an electronic claim form, you must include four data elements. Those include the beneficiary’s first name or initial, last name, Medicare Beneficiary Identifier (MBI) or Health Insurance Claim Number (HICN), and birth date. Caution: The date of the patient’s eligibility is important. Changes that occur around policy-renewal time can impact coverage. For instance, if...

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