Medicare IVR - important points to follow

INTERACTIVE VOICE RESPONSE (IVR)

The IVR will provide eligibility and benefits information, claim and payment information, redetermination status, duplicate remittance advice and general information to the user.


The caller will need to have the following information when using the IVR:

* National Provider Identifier (NPI) number.

* Provider Transaction Access Number (PTAN).

* The last five digits of the Tax Identification Number (TIN).

*  Patient’s Medicare number.

*  Patient’s date of birth.

*  Patient’s last name.

*  Patient’s first name.

The IVR will give the following eligibility and benefits information:

*Part A and Part B effective and termination dates.

*Part B deductible for the current year.

*Part B deductible for prior years (Part B only).

*Physical and speech-language pathology cap information.

*Occupational therapy cap information.

*Managed care enrollment.

*Medicare Secondary Payer (MSP) information.

*Benefits under a different Medicare number.

*Hospice enrollment.

*Home health enrollment.

*Verification if the patient has received the pneumonia vaccine.

When using the IVR, providers must obtain complete patient eligibility to ensure claims are processed timely and accurately with unnecessary claim denials.



Key eligibility components that should be verified on the IVR are:

*Medicare effective and termination dates.

*Deductible information.

*MSP information.

*Coverage under a Medicare Advantage (MA) managed care plan.

Reminder: The IVR is a valuable resource for providers, but without complete patient information the IVR will not release patient eligibility information. It is important to obtain the patient’s complete name as it is listed on the Medicare card, the patient’s Medicare number, and their birth date. The IVR will not provide the needed information if the provider does not have valid patient information.