When performing an eligibility inquiry, why do I receive an error message that the beneficiary I requested cannot be found?

Answer:
To protect the privacy of beneficiary data, CMS's HIPAA Eligibility Transaction System (HETS) 270/271 system, that we are required to use for all eligibility transactions, will not return data when all fields entered do not match the beneficiary’s data as it is maintained in HETS. You may enter data into optional fields, but these fields are not required to receive a valid Medicare beneficiary eligibility benefit response. If data entered into an optional field does not match the beneficiary's data maintained in CMS's HETS system, eligibility data will not be returned on the eligibility response tabs.

If the beneficiary has a hyphenated name or a name suffix, it may need to be entered differently in your eServices inquiry than how it appears on the Medicare card. The HETS system does not allow special characters, therefore hyphenated names may be listed in HETS with a space or as a combined single name. In addition, name suffixes may be listed in HETS as part of the last name or as in the separate 'Subscriber Name Suffix' field. If the beneficiary's name contains a suffix, please try entering it in the 'Subscriber's Last Name' field first when performing the eligibility inquiry in eServices.

Please reference section 6 of the eServices User Manual (PDF, 8.21 MB) for screenshots and additional information on the eServices eligibility function.