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.
