Insurance eligibility

Insurance eligibility response - understanding

Understanding the Eligibility Response

When you use Provider Electronic Solutions software, or AVRS to verify eligibility, the system returns a detailed eligibility response. You will receive confirmation of the information displayed on the recipient’s plastic card, along with verification that the recipient is eligible or ineligible for services performed on the requested From Date of Service (FDOS). The eligibility response also returns the following information:

• Recipient’s aid category

• Lock-in information

• Managed Care or Medicare affiliation, if applicable

• Third party information

• Maternity Waiver

• Benefit Limits

• Dental Benefit Limits