Pathology/Lab Coding Alert

Question: We’re trying to verify a Medicare beneficiary’s eligibility with our MAC using an electronic claim form, and we’re having trouble. What elements are required to accomplish the verification?

Florida Subscriber

Answer: To verify your patient’s Medicare eligibility using an electronic claim form, you must include four data elements. Those include the beneficiary’s first name or initial, last name, Medicare Beneficiary Identifier (MBI) or Health Insurance Claim Number (HICN), and birth date.

Caution: The date of the patient’s eligibility is important. Changes that occur around policy-renewal time can impact coverage. For instance, if a beneficiary changes to a Medicare Advantage plan and provides you with the card before the new policy is effective, that can cause problems with verification.