Check Eligibility Page
You use the Check Eligibility page of Member to search for members to view their eligibility.
The Check Eligibility page contains the following panels:
Requester Fields
| Field | Description |
|---|---|
| Information is displayed when the Check Eligibility page is accessed. Information cannot be edited. | |
| Provider ID | A unique identifier number for a provider of health care services. Automatically completed by the system. |
| Provider Name | The name of the provider. |
| Payer ID |
A unique identifier number for the payor of health care services. Automatically completed by the system. |
| Payer Name | The name of the payor. |
Member Information Fields
| Field | Description |
|---|---|
To add a second row to your search criteria, click  (the add icon). To remove a row from your search criteria click  (the delete icon). To inquire about a specific member's eligibility, you must enter one of the following three criteria: member ID, date of birth, last name, or first name. The service date defaults to the current date if the service from and service to date is not entered. |
|
| Member ID | A unique identifier number given to an eligible Medicaid member. |
| Date of Birth | The date the member was born |
| Last Name |
The legal last name of the person. Examples: Stone, Smith, Jones, Apple |
| First Name |
The legal first name of the person. Example: Ida |
| MI |
The middle initial of the person's name. Format: 1 character Examples: A, B, C, I, O, E |
| Gender |
The gender of a person, usually male or female. In some cases, the gender may also be unknown. |
| SSN |
A nine-digit number assigned by the Federal government, usually assigned at the time of birth and used for tax purposes. Format: NNN-NN-NNNN or NNNNNNNNN Example: 123-45-6789 Note: This field cannot contain all zeros. |
| Service From Date |
The date the member became eligible for benefits. Format: MM/DD/YYYY Example: 06/12/2011 |
| Service To Date |
The date the member's eligibility expires. Format: MM/DD/YYYY Example: 06/12/2011 |
| Service Type Code | The type of service. |
Search Results Fields
| Field | Description |
|---|---|
| Member ID | A unique identifier number given to a Medicaid member. |
| Date of Birth |
The date the person was born; the person's date of birth. Format: MM/DD/YYYY Example: 05/23/1935 |
| Last Name | The member's legal last name. |
| First Name | The member's legal first name. |
| MI | The middle initial of the member's legal name. |
| Gender |
The gender of a person, usually male or female. In some cases, the gender may also be unknown. |
| SSN |
A nine-digit number assigned by the Federal government, usually assigned at the time of birth and used for tax purposes. |
| Service From Date | The date the member became eligible for benefits. |
| Service To Date | The date the member's eligibility expires. |
| Service Type Code | The type of service. |
| TPL |
An indicator for third party liability coverage, such as when a member has coverage in addition to Medicaid. |