Anthem’s New Medicare Validation

/in , /by

Medicare Validation is Now Available on mProducer with Anthem

Starting Saturday, 12/14/2019, Brokers can perform Medicare validation using mProducer.  mProducer will return the following information: 

  • Medicare Part A Effective Date
  • Medicare Part B Effective Date
  • Current Contract Code
  • Drug Gap in Months
  • LIS Validation
  • LIS Level
  • Date LIS Last Used as an SEP

 

It’s simple!  Just click on the landing page tile Eligibility Check: Medicare and Medicaid, enter the client’s name, date of birth, proposed effective date, and Medicare Beneficiary Identifier (MBI).  Then click Check Eligibility.

 

If you have been requesting D-SNP validation using mProducer, take note!

  • The DSNP Eligibility Check tile has been renamed Eligibility Check: Medicare and Medicaid to reflect the enhancement for Medicare only validation.
  • When performing DSNP validation, you will now click on the Eligibility Check: Medicare and Medicaid tile and then click on the DSNP Eligibility Check tab.

Medicare Only Validation and D-SNP Validation Updates

  • The field titled Do they have LIS? has been renamed Do they have LIS for the Proposed Effective Date? to make that clear.
  • You can no longer perform validations with HICN due to CMS replacing HICN with MBI.  You MUST use the MBI.

 

D-SNP Validation Updates

  • When your client is ineligible for a D-SNP plan, it is because he does not have an eligible Medicaid level, or does not have Medicaid.  The values for MEDICAID LEVEL have been updated to differentiate between these two scenarios.
    • If a client does not have an active Medicaid policy, the MEDICAID LEVEL will indicate No Medicaid.
    • If the client does have an active Medicaid policy, the response will display the Medicaid level, or Unqualified if the Medicaid level cannot be interpreted from the state data.
  • Submitting DSNP applications is quicker than ever!  When you submit the application directly after performing the D-SNP validation, mProducer will automatically populate the application with Medicare Part A and Part B effective dates, MBI, and Medicaid Number or SS, reducing data entry!