Interactive Voice Response (IVR) Enhancements Effective 03/03/2007

Home Provider Part B Publications 2007 Archives

As previously communicated, WPS will be upgrading the IVR with added features and new security requirements. The new IVR changes will take effect on March 3, 2007. Outlined below are the detailed descriptions of the modifications. The new IVR brochure will be available for download on March 5, 2007.

Eligibility changes -

  • Gender authentication. The IVR will no longer authenticate or prompt the caller for the beneficiary's gender.


  • Corrected Health Insurance Claim Number (also known as the HICN or Medicare number). The IVR will now voice back to the caller the corrected HICN if a previously assigned HICN was used by the caller to obtain eligibility. (The caller will also hear the corrected HICN while in the claim status menu option).


  • Date of death. The IVR will now provide the beneficiary's date of death in the general eligibility section.


  • Eligibility details. After general eligibility is played, there will be a new option for the caller to request eligibility details. The information listed below is what will be heard in the eligibility details section.


  • Medicare Secondary Payer (MSP). The MSP type (working aged, liability, etc.) will be played to the caller as well as effective and term dates if applicable. Up to two valid records will be played.


  • Health Maintenance Organization (also known as an HMO or Medicare Advantage Plan). The HMO plan ID will be played as well as effective and term dates if applicable. Up to two valid records will be played. The HMO name and type (cost versus risk) will be played as before. Providers will be reminded to submit their claims to the proper payer. Please note that if a beneficiary is enrolled in an HMO, the IVR will state that Medicare is primary. It is important that the provider listen to whether the IVR states the HMO is a risk-type HMO or cost-type HMO. If the HMO is a risk-type, providers may only bill the HMO. If the HMO is a cost-type, providers may bill the HMO or WPS as the Medicare Part B Carrier. Please refer to Chapter 1 of Publication 100-04 on the Centers for Medicare and Medicaid Service's (CMS's) website for further details on claim submission.
    http://www.cms.hhs.gov/manuals/downloads/clm104c01.pdf adobe portable format document


  • Crossover. The crossover company name will be played for up to two valid records. Note that the caller may hear the same name twice; this is due to constraints in programming. Note also, the name is voiced back to the caller using text-to-speech technology and may not be pronounced properly.


  • Home Health. The home health information has been moved to the "details" section and will play as before - whether the beneficiary is receiving home health and the date home health was discontinued.


Claim status changes -

  • Patient name as an added validation element. The IVR will now ask for and verify the patient's name in the claim status menu option as an added security layer.


  • Non-assigned claims. For security reasons, the IVR will only provide the following information on non-assigned claims - whether the claim has been received, date it finalized or if it's in process, and whether the claim crossed over.


  • Deported and incarcerated beneficiaries. The IVR will now check to see if a beneficiary has either an incarcerated or deported record on CWF. In the extremely rare instance that there is a valid record, the IVR cannot release any claim information for that beneficiary. The IVR will play a message - "I'm sorry, we are unable to provide claim information for this beneficiary." The IVR will then refer the caller to a Customer Service Representative (CSR) as CSR's can provide claim information in these situations.


  • Corrected HICN. If the caller gives a HICN that has been corrected/changed, the IVR will voice back to the caller the corrected number. The IVR will use the corrected number to obtain claim status.


Deductibles changes -

  • Gender authentication. The IVR will no longer authenticate or prompt the caller for the beneficiary's gender.


    • Overall menu changes and the "I have a question" prompt -

    • Phone numbers, addresses, and the appeal rights message have been moved to a new section called "I have a question." The menu will look as follows.
      1. Eligibility
      2. Claim Status
      3. Provider Summary
      4. Checks
      5. Deductibles
      6. Pricing
      7. I have a Question
        1. Medicare News
          (Up to 9 messages determined and maintained by WPS)
        2. Appeal Rights
        3. Phone Numbers
        4. Addresses


  • There will be a new submenu option within "I have a question" called Medicare News. This will play up to nine informational messages and is controlled and updated by WPS.


  • Changed HICNs. In certain situations when a Medicare number has changed, and the IVR is unable to retrieve the new number, the IVR will voice a message to tell the caller that the Medicare number has possibly changed and to contact the beneficiary for the new number.


We believe the provider community will benefit from the additional information the IVR will provide. It is our goal to remain committed to enhancing this self-service application while remaining vigilant to beneficiary's security and privacy. Looking to the future, integrating the National Provider Identifier (NPI) into use with the IVR will be the next greatest upcoming modification. Look for future announcements on the looming upgrade.

Page Last Updated: Wednesday, 17-Feb-2010 13:39:50 CST