verify insurance eligibility

How to verify insurance eligibility - effective dates

Confirming Eligibility

Whenever possible, providers should verify eligibility prior to providing service. To verify eligibility, providers should perform the following:

Step 1  Request to see the recipient’s plastic card, or a copy of the eligibility notification letter.

Step 2  Ask to see a driver’s license or other picture identification for adult recipients.

Step 3  Perform eligibility verification using one of the methods described in Section 3.2, Confirming Eligibility.

Step 4 Review the entire eligibility response, as applicable, to ensure the recipient is eligible for the service(s) in question. Please note that the eligibility response provides lock-in, third party, managed care and dental information. You need all the available information to determine whether the recipient is eligible for Medicaid.

Step 5 Maintain a paper copy of the eligibility response in the patient’s file to reference, should the claim deny for eligibility.

 

If the claim denies for ineligibility, the provider may contact the HP Provider Assistance Center to review the eligibility verification receipt and discuss the reasons the claim denied.

Providers may use various resources to verify recipient eligibility:

• Provider Electronic Solutions software

• Software developed by the provider’s billing service, using specifications provided by HP

• Automated Voice Response System (AVRS) at 1 (800) 727-7848

• Contacting the HP Provider Assistance Center at 1 (800) 688-7989