Changes to the Interactive Voice Response (IVR) Disclosure Requirements for Claims Information
To meet the Centers for Medicare & Medicaid Services (CMS') requirements for beneficiary data disclosure as defined in the Internet Only Manual (IOM) Publication 100-9, Medicare Contractor Beneficiary and Provider Communications Manual, Chapter 6, Section 80, Palmetto GBA will authenticate four beneficiary data elements prior to the disclosure of beneficiary information for 'claims status.' These elements are:
- The beneficiary's last name
- The initial of the beneficiary's first name
- Current or previously assigned Health Insurance Claim Number (HICN)
- The date of service
Palmetto GBA's IVR currently requires the authentication of the beneficiary's HICN and date of service, but does not require the provider to authenticate the beneficiary's name. Effective June 8, 2009, our IVR will also require that you enter in the beneficiary's last name and initial of their first name when you are requesting claims status information.
We appreciate your understanding and cooperation as we safeguard our Medicare beneficiaries' Protected Health Information (PHI).