February 6, 2018
Checking Beneficiary Eligibility Using the Common Working File Queries
Change Request (CR) 10098, and the corresponding MM10098 article were issued to inform providers that effective January 1, 2018, the CWF Provider Queries, ELGA, ELGH, HIQA, HIQH, and HUQA will only accept the National Provider Identifier (NPI) as a valid Provider Number. The Provider Transaction Access Number (PTAN) is no longer used to access eligibility information.
Below is a screen example of the ELGH eligibility screen (The ELGA entry screen is identical).
To check beneficiary eligibility using ELGA or ELGH, enter the following information:
Field Name | What to Enter |
---|---|
HIC / MBI Number | The beneficiary's Health Insurance Claim (HIC) number or their Medicare Beneficiary Identifier (MBI) number. NOTE: Beginning April 2018 through the end of the New Medicare Card transition period, you can submit either a HIC or MBI in ELGA/ELGH. Beginning January 1, 2020, the MBI must be used to access eligibility information. Refer to the CMS New Medicare cards website for additional information. |
SURNAME | The beneficiary's last name (six position field) If the beneficiary's name is John Smith Jr., enter "SMITHJ" |
INITIAL | The first letter of the beneficiary's first name. |
DATE OF BIRTH | The beneficiary's date of birth in a MMDDCCYY format |
SEX CODE | The beneficiary's gender (M or F). |
REQUESTOR ID | The requestor ID number 0011 |
INTER NO | The Medicare intermediary number
|
NPI NO | The facility's National Provider Identifier (NPI) |
HOST ID | Leave blank or enter one of the host IDs shown |
APP DATE | Leave blank or enter the date of admission to your facility. |
For additional information about ELGA/ELGH, refer to the following resource.
- Home Health and Hospice - FISS Direct Data Entry (DDE) Guide, Chapter 2: Checking Beneficiary Eligibility
- Kentucky/Ohio Part A providers - FISS Direct Data Entry (DDE) Guide, Chapter 2: Checking Beneficiary Eligibility