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Requirements for
Obtaining Eligibility or Claim Status
When you call Empire Medicare Services
and use either the Interactive Voice Response (IVR)
application, or speak directly to a customer service
representative about a patient or claim data, you are
required to provide certain pieces of information before
a response can be provided.
Outlined below are the guidelines that
the Centers for Medicare & Medicaid Services (CMS)
has issued:
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If the contact
is:
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AND:
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You must
provide:
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A provider, physician, or
supplier
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You need information about a
claim
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The provider, physician, or
supplier’s name and identification number The
patient’s last name and first initial
Patient’s HIC number Date of service
(The items must match exactly)
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A provider, physician, supplier,
or billing service/clearinghouse
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You need information about the
patient’s eligibility. (This information may
only be used in order to submit an accurate
claim.)
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The provider, physician, or
supplier’s name and identification number The
patient’s last name and first initial
Patient’s HIC number Patient’s date of
birth Patient’s gender (The items
must match exactly)
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Empire’s customer service
representatives will not be able to release any
information to you unless all information in the table
above is an exact match to what we have on file (e.g.,
the nine-digit Medicare number including any alpha
suffixes). Be sure to make a copy of the patient’s
Medicare card for quick reference.
Posted: 11/11/2004
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