Detailed HMO Information is Available in the IVR
Did you know? Once you receive general eligibility information via the Interactive Voice Response System (IVR), you can simply say "details" to hear whether the beneficiary is enrolled in an HMO. If the beneficiary is enrolled in an HMO, the following will play:
- HMO effective and termination dates
- HMO plan code
- HMO name and phone number, if available
- HMO type (cost vs. risk)
Please note:
It is very important that you listen to what type of HMO the beneficiary may be enrolled in. A cost type, also known as a non-restrictive HMO, means that you may bill WPS Medicare or the HMO directly. A risk type, also known as a restrictive HMO, means that you may only bill the HMO. Any claims billed to WPS Medicare for a beneficiary enrolled in a risk type HMO will be denied by WPS Medicare for the claim not being covered by this payer/contractor.
For a complete list of IVR instructions, please refer to the WPS Medicare Website:
http://www.wpsmedicare.com/part_b/publications/ivrsystem.shtml
Page Last Updated: Thursday, 18-Mar-2010 05:55:27 CDT
