Upcoming Changes: Checking Medicare Eligibility
Within the next two months, providers will no longer be able to verify Medicare beneficiary eligibility over the phone. This article will summarize these changes and provide alternative methods for verifying eligibility.
What You Need to Know
On September 27, 2024, CMS published a Change Request, directing Medicare Administrative Contractors (MACs) to disable beneficiary eligibility information from their Interactive Voice Response (IVR) systems. This regulation was created to protect Medicare beneficiaries from fraud, ensuring that eligibility information is only available on secured platforms. All MACs are required to make this change no later than March 31, 2025, however, CGS announced that their IVR eligibility information will be disabled starting February 28, 2025 at 5 pm CT. Once disabled, providers will be required to verify eligibility using one of the following:
- DME MAC online provider portal
- Billing agencies, clearinghouses, or software vendors
- HIPAA Eligibility Transaction System (HETS)
What this Means for You
If you currently verify Medicare eligibility over the phone, you will be required to use a different method by March 1st for CGS and by April 1st for Noridian. We recommend switching to one of the platforms listed above as soon as possible to allow time for registration and learning the new system. For more information on these alternative methods, you can review the Checking Medicare Eligibility MLN Fact Sheet. You can also check the Noridian Schedule of Events and/or CGS Calendar of Events for live webinars focused on verifying eligibility using their respective provider portals, Noridian Medicare Portal and myCGS.