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Eligibility Verification

It is important that you verify member eligibility on the date of service. Viewing a Hoosier Health Card alone does not ensure member eligibility - neither does having prior authorization on file.

If you fail to verify eligibility on the date of service, you risk claim denial if, for example, the member was not eligible on the date of service, or the service provided was outside the member's scope of coverage.

Any of the following eligibility verification tools can be used to verify the status of a member's eligibility for current and past dates of service.

Web interChange

Web interChange is a secure Web site that allows you to perform multiple functions including obtaining eligibility information, filing claims, and checking claim status. It is fast and easy to use. Online help is available through the eligibility verification process. For more information, please see Chapter 3 of the IHCP Provider Manual.

Omni 380 terminal

The Omni 380 terminal, more commonly referred to as the Omni swipe card device, is another option for eligibility verification. It is designed to take advantage of the magnetic strip on the member's Hoosier Health Card but information can also be entered manually.

Note: HP is no longer able to provide new Omni 380 terminals. However, support of existing Omni terminals and printers is ongoing.

For instructions about how to use the Omni terminal, please see Chapter 3 of the IHCP Provider Manual.

Automated Voice Response (AVR)

The Automated Voice Response (AVR) system enables you to obtain eligibility, basic claim status, and checkwrite information through the use of a touch-tone telephone. For instructions about how to use AVR, please read Chapter 3 of the IHCP Provider Manual.

270/271 eligibility inquiry and response transaction - batch or interactive

The 270/271 eligibility benefit request and response is a Health Insurance Portability and Accountability (HIPAA)-compliant electronic transaction. For more information about electronic transactions, see EDI Solutions.

More information

For more information, see the following chapters of the IHCP Provider Manual:

• Chapter 2 - Member Eligibility and Benefit Coverage
  
• Chapter 3 - Electronic Solutions