Eligibility Confirmation Page

You use the Check Eligibility Details page to view member eligibility details.

The Check Eligibility Details page contains the following panels:

You can open or close certain panels. Click Plus sign icon (the plus sign) beside a panel to open the panel. Click Minus sign icon (the minus sign) to close the panel.

Confirmation Fields

Field Description
Service Date From

The date the member became eligible for benefits.
Service Date To

The date the member's eligibility expires.
Confirmation Number The member's confirmation number.

 

Member Information Fields

Field Description
Last Name The last name of the selected member.
First Name The first name of the selected member.
Middle Initial The middle initial of the selected member.
Suffix The suffix of the name for the selected member.
Date of Birth

The date the person was born; the person's date of birth.

Format: MM/DD/YYYY

Example: 05/23/1935

Member ID

 A unique identifier number given to a Medicaid member.
SSN

A nine-digit number assigned by the Federal government, usually assigned at the time of birth and used for tax purposes.
Street Address The mailing address for the select member.
P.O. Box The post office box if applicable for the select member.
City The city of the address for the select member.
State The state of the address for the select member.
Zip The zip code and extension of the address for the select member.

 

Community Engagement Fields

Field Description
Current Community Engagement Suspension Status This is the member's current community engagement suspension status as of the date the inquiry was submitted. The possible values are Suspended, Not Suspended and Not Applicable

 

Eligibility Status Fields

Field Description

The eligibility status information is displayed for each active (non-voided) eligibility span as of the selected date.

Tip: If a member is eligible for both Medicaid and Qualified Medicare Benefits (QMB) during the specified time period, both spans are displayed on the eligibility status when the member's Medicaid eligibility span begin and end dates fully or partially overlap the service begin and end dates, and the QMB span begin date is greater than the Medicaid span begin date and less than or equal to the Medicaid span end date and the QMB span end date is greater than to the Medicaid span end date.
Eligibility Type The member's category of eligibility for Medicaid benefits.
Eligibility From Date The date the member became eligible for benefits.
Eligibility To Date The date the member stopped being eligible for benefits.
Community Re-entry This code indicates if the member entered the Community Re-entry Program from a juvenile or adult correction facility.

 

Benefit Plan Fields

Field Description
The information displays plan information for each active (non-voided) benefit plan span as of the selected date.
Plan Description A description of a member's benefit plan.
Plan From The date the member's benefit plan became effective.
Plan To The date the member's benefit plan expired.
MCO The care management health insurance provider.
Phone The phone number of the care management health insurance provider.

 

Covered Services Fields

Field Description
To expand the Covered Service panel, click The plus sign (the plus sign). The displayed spans provide information for each active (non-voided) covered service for the benefit plan spans as of the selected date.
Plan Description A description of a member's benefit plan.
Service Type

The type of service covered by the benefit plan.

Examples: Vision Care, Dental Care, Prescription Drug, Open Access, HMO, Part B
Covered Service From Date The date the member's benefit plan became effective.
Covered Service To Date The date the member's benefit plan expired.

 

Copay Fields

Field Description
To expand the Copay panel, click The plus sign (the plus sign). The displayed spans provide information for each active (non-voided) co-payment paid on the benefit plan spans as of the selected date.
Service Type

The type of service performed for the member.

Examples: Office Visit, Hospital Inpatient, Brand Name Prescription, Generic Prescription Drug
Description

The description of the type of service performed.

Examples: Primary Care Physician Visit, Hospital Inpatient Admission, Preferred Brand Prescription Drugs, Generic Prescription Drug.
Copay Amount The amount of the co-payment.
Copay Begin Date The start date that co-payments began.
Copay End Date The date that co-payment ended.
Copay Type

The type of co-payment made.

Examples: Dollar Per Visit, Dollar per Admission

 

TPL/Medicare Spans Fields

Field Description
To expand the TPL/Medicare Spans panel, click The plus sign (the plus sign). The displayed spans provide information for each active (non-voided) third party liability span as of the selected date.
Carrier ID The Medicaid carrier's identification number.
Carrier Name The name of the third party liability benefit carrier.
Insurance Type The type of third-party insurance the member has, such as Medicare Part D
Policyholder ID The policy holder's identification number.
Policyholder Name The policy holder's full name.
Policy Number The policy holder's identification number.
Policy Begin Date The date the Medicaid policy began.
Policy End Date The date the Medicaid policy expired.

 

Lock-in Spans Fields

Field Description
To expand the Lock-in Spans panel, click The plus sign (the plus sign). The displayed spans provide information for each active (non-voided) lock-in span as of the selected date. Pharmacy lock ins spans are not included in this information.
Begin Date The date Medicaid benefits began.
End Date The date Medicaid benefits ended.
Provider ID A unique identifier number for a Provider of healthcare services.
Provider Name The servicing provider's name.
Lockin Type

An identifier for the type of benefits and services a member can receive from Medicaid.

Example: M-Medical