Beneficiary Eligibility: Online Transactions

Use Palmetto GBA’s eServices portal to access beneficiary eligibility information, including the effective date of a patient’s Medicare benefits such as hospice enrollment and whether the patient is enrolled in fee-for-service (original) Medicare or a Medicare Advantage plan. All providers that have an EDI Enrollment Agreement on file may register to use this tool. Beneficiary eligibility information may be found in the eServices User Manual (PDF, 7.59 MB).

One Important Consideration
Only one provider administrator per EDI Enrollment Agreement/PTAN/NPI combination performs the registration process. Billing services and clearinghouses should contact their provider clients to gain access to the system.

Palmetto GBA providers can also access Medicare patient eligibility information by phone through our Interactive Voice Response (IVR) system, as well as through the ANSI X12 270/271 transaction. 

HIPAA Eligibility Transaction System (HETS) for 270/271
CMS offers real-time Internet-based eligibility transactions as an alternative to the IVR. These 270/271 transactions are processed through the CMS data center. Providers and clearinghouses must be authenticated by CMS before conducting these transactions. Telecommunications software is also required in order to access the CMS network. For more information, visit the HIPAA Eligibility Transaction System(HETS) overview page.