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December 15, 2015

Checking Beneficiary Eligibility and Redetermination Claim Status on the IVR

Part B providers may use the Interactive Voice Response (IVR) to request beneficiary eligibility and redetermination status.  Beneficiary eligibility and redetermination status information is available between 6 a.m. and 8 p.m. ET. With a touch-tone phone, you can obtain the latest information.

According to the Centers for Medicare & Medicaid Services (CMS) providers are required to use the Interactive Voice Response (IVR) system for claim status and eligibility Information. Therefore, customer service representatives (CSRs) will ensure that these routine inquiries are handled by the IVR so they are available to handle more difficult and complex issues.  Refer to the CMS Medicare Contractor Beneficiary and Provider Communications Manual, (Pub. 100-09), Chapter 6, section 50.1External PDF, which states:

Providers shall be required to use IVRs to access claim status and beneficiary eligibility information. CSRs shall refer providers back to the IVR if they have questions about claims status or eligibility that can be handled by the IVR. CSRs may provide claims status and/or eligibility information if it is clear that the provider cannot access the information through the IVR because the IVR is not functioning.

You may access the Part B IVR at 1.866.290.4036.  Additional IVR resources on cgsmedicare.com include the CGS Jurisdiction 15 Part B Interactive Voice Response (IVR) User GuidePDF and the IVR steps guide.

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