Checking Beneficiary Eligibility
Medicare Administrative Contractor, Cahaba Government Benefits Administrators®, LLC
(Cahaba GBA)
Checking Beneficiary Eligibility using ELGA/ELGH
2
Checking Beneficiary Eligibility using ELGA/ELGH
Information Necessary to Check Eligibility
2
3
Accessing ELGA and ELGH
Information about the HOST ID Field
Information about the APP DATE Field
4
7
8
ELGA/ELGH Screen Examples and Field Descriptions
ELGA Screen Page 01—Beneficiary Information (Beneficiary
Entitlement, Hospital and SNF Days, Medicare Advantage Plan
Information)
ELGA Screen Page 02—Hospice Information
ELGA Screen Page 03 (Home Health Benefit Periods)
ELGA Screen Page 04, (Home Health PPS Episodes)
ELGA Screen Page 05 (Screening Information)
ELGA Screen Page 06 (Next Eligible Date)
ELGA Screen Page 07 (Next Eligible Date)
ELGA Screen Page 08 (Smoking Cessation)
ELGA Screen Page 09 (Medicare Secondary Payer (MSP) Information)
ELGH Screen Page 01 (Beneficiary Entitlement Information)
ELGH Screen Page 02 (Home Health Benefit Information)
ELGH Screen Page 03 (Home Health PPS Episodes)
ELGH Screen Page 04 (Medicare Secondary Payer (MSP) Information)
ELGH Screen Page 05 (Medicare Advantage Plan Information)
ELGH Screen Page 06 (Next Eligible Date)
ELGH Screen Page 07 (Next Eligible Date)
ELGH Screen Page 08 (Smoking Cessation)
ELGH Screen Page 09 (Hospice Information)
10
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Fiscal Intermediary Standard System Reference Guide
December 2013
Checking Beneficiary Eligibility
Medicare Administrative Contractor, Cahaba Government Benefits Administrators®, LLC
(Cahaba GBA)
Disclaimer
This educational material was prepared as a tool to assist Medicare providers and other
interested parties and is not intended to grant rights or impose obligations. Although every
reasonable effort has been made to assure the accuracy of the information within this module,
the ultimate responsibility for the correct submission of claims lies with the provider of services.
Cahaba GBA employees, agents, and staff make no representation, warranty, or guarantee that
this compilation of Medicare information is error-free and will bear no responsibility or liability
for the results or consequences of the use of these materials. This publication is a general
summary that explains certain aspects of the Medicare Program, but is not a legal document.
The official Medicare Program provisions are contained in the relevant laws, regulations, and
rulings.
We encourage users to review the specific statues, regulations and other interpretive materials
for a full and accurate statement of their contents. Although this material is not copyrighted, the
Centers for Medicare and Medicaid Services (CMS) prohibits reproduction for profit making
purposes.
Fiscal Intermediary Standard System Reference Guide
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December 2013
Checking Beneficiary Eligibility
Medicare Administrative Contractor, Cahaba Government Benefits Administrators®, LLC
(Cahaba GBA)
Checking Beneficiary Eligibility using ELGA/ELGH
Cahaba encourages you to check the beneficiary’s Medicare eligibility often. Eligibility
should be checked at least prior to admission, monthly and prior to submitting billing
transactions for processing. Checking eligibility information allows you to identify critical
information such as whether the beneficiary is/has:
 entitled to Medicare Part A, Part B, or both Part A and Part B
 enrolled in a Medicare Advantage (MA) plan
 enrolled with another insurance that is primary over Medicare
 in an open 60-day HH PPS (Home Health Prospective Payment System) episode
 in an open hospice election period
 inpatient or skilled nursing facility (SNF) benefit days available
 met their deductible requirements
 met the therapy cap for the calendar year
Eligibility records, which are maintained for CMS (Centers for Medicare & Medicaid Services)
by the Social Security Administration, are stored electronically in the CWF (Common Working
File) system. You can access CWF records to view eligibility information via the eligibility
screens, ELGA (Part A Eligibility) or ELGH (Home Health and Hospice Eligibility) provided
that you have identifying information about your beneficiary.
All provider types may access both ELGA and ELGH; however, hospitals and skilled nursing
facilities (SNFs) will typically access ELGA, and home health and hospice providers will
typically access ELGH. It may be necessary to use both ELGA and ELGH to obtain all the
necessary eligibility information for a beneficiary depending upon the services being billed to
Medicare.
NOTE: CMS has advised through Medicare Learning Network (MLN) Matters® article,
SE1249 that providers will need to begin using the Medicare Health Insurance Portability and
Accountability Act (HIPAA) Eligibility Transaction System (HETS) to verify beneficiary
eligibility information as the ELGA / ELGH screens will no longer be available effective April
2014. Please see MLN article, SE1249 at http://www.cms.gov/Outreach-andEducation/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1249.pdf
for additional information.
Fiscal Intermediary Standard System Reference Guide
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December 2013
Checking Beneficiary Eligibility
Medicare Administrative Contractor, Cahaba Government Benefits Administrators®, LLC
(Cahaba GBA)
Information Necessary to Check Eligibility
You must have the following five pieces of information about the beneficiary to check eligibility:
1.
HIC (Health Insurance Claim) Number (also called their Medicare number)
2.
First initial of first name
3.
Last name
4.
Date of birth (MMDDCCYY format)
5.
Gender
Prior to accessing ELGA/ELGH, you should verify the information listed above matches the
information on the beneficiary’s red, white and blue Medicare card.
You must also have your Medicare Provider Transaction Number (PTAN) and Cahaba GBA’s
intermediary number (see “Accessing ELGA and ELGH” below) to check eligibility.
The following provides information about the ELGA/ELGH eligibility screens.
 - Draws your attention to the tips.
 - Draws your attention to examples.
Fiscal Intermediary Standard System Reference Guide
3
December 2013
Checking Beneficiary Eligibility
Medicare Administrative Contractor, Cahaba Government Benefits Administrators®, LLC
(Cahaba GBA)
Accessing ELGA and ELGH
1.
To access ELGA and ELGH as you sign in to the FISS, type the letters ELGA or ELGH
where you would normally type FSS0 and press ENTER.
elga
SIGN-ON IS COMPLETE;NO INVALID ATTEMPTS;LAST ACCESS 15:58:24 08/15/2007.
Screen example for all other providers.
elgaWELCOME TO CMS EDC AT EDS(CICSA141)- IOWA PART A PRODUCTION
A C P F A 1 4 1
MVS/ESA
NETNAME: V12M3072 TERMINAL: $111
AAAAAAAAAA
AAAAAAAAAAAA
AA
AA
AA
AA
AA
AA
AAAAAAAAAAAA
AAAAAAAAAAAA
SP7.0.7 M2094
DATE: 12/11/07
11
444
111
4444
1111
44 44
11
44 44
11
44
44
11
44444444444
11
444444444444
C I C S 6.3.0
TIME: 08:14:54
11
111
1111
11
11
11
11
To access ELGA or ELGH if you are already in FISS, press F4 at any time to terminate
your session. You will see the Session Successfully Terminated message on your screen.
Type the letters ELGA or ELGH over the word Session and press ENTER.

Providers may wish to use the instructions for accessing multiple sessions simultaneously
found in the “FISS Overview” section of this resource. By following these instructions you
can be signed on to FISS and to ELGA or ELGH at the same time without the need to
terminate your session. You may also contact your connectivity vendor to learn how to
access multiple sessions simultaneously.
SESSION SUCCESSFULLY TERMINATED
elgaION SUCCESSFULLY TERMINATED
Fiscal Intermediary Standard System Reference Guide
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December 2013
Checking Beneficiary Eligibility
Medicare Administrative Contractor, Cahaba Government Benefits Administrators®, LLC
(Cahaba GBA)

Remember that ELGA and ELGH are not menu options within FISS. You must be in the
process of signing on or off of FISS in order to access ELGA or ELGH.
2.
Once you have pressed Enter, the CWF Part A Eligibility System screen appears. The
fields on the screen will be identical for both the ELGA and ELGH eligibility screens.
ELGA
CWF PART A ELIGIBILITY SYSTEM
ELGASAT1
MM/DD/CCYY HH:MM:SS
INQUIRY BY PROVIDERS
ENTER THE FOLLOWING FIELDS:
HIC NUMBER
:
SURNAME
:
INITIAL
:
DATE OF BIRTH :
(MMDDCCYY)
SEX CODE
:
REQUESTOR ID
:
INTER NO
:
NPI INDICATOR :
N-NPI or Blank
PROVIDER NO
:
HOST-ID
:
GL, GW, KS, MA, PA, NE, SE, SO, SW
APP DATE
:
(MMDDCCYY)
REASON CODE
: 1
RESPONSE CODE : P
3.
Follow the instructions in the table below to complete the required fields:
Field Name
What to Enter
HIC NUMBER
The beneficiary’s Health Insurance Claim (HIC) number.
SURNAME
The beneficiary’s last name (only accepts up to 6 letters).
INITIAL
The first letter of beneficiary’s first name.
DATE OF BIRTH
The beneficiary’s date of birth in a MMDDCCYY format.
SEX CODE
The beneficiary’s gender (M or F).
REQUESTOR ID
The requestor ID number. 0010
INTER NO
The Medicare intermediary number. 00010
NPI INDICATOR
The National Provider Indicator (NPI). Determines the type of
provider number entered in “PROVIDER NO” field. Leave blank.
PROVIDER NO
Your facility’s Provider Transaction Access Number (PTAN)
(previously known as a Legacy number or Oscar).
HOST ID
Usually left blank or insert one of the following. See the table under
“Information About the HOST ID Field” below.
GL – Great Lakes GW – Great Western KS – Keystone
MA – Mid-Atlantic PA – Pacific
NE – Northeast
SE – Southeast
SO – South
SW– Southwest
Fiscal Intermediary Standard System Reference Guide
5
December 2013
Checking Beneficiary Eligibility
Medicare Administrative Contractor, Cahaba Government Benefits Administrators®, LLC
(Cahaba GBA)
Field Name
What to Enter
APP DATE
Leave blank or key the date of beneficiary’s admission or Medicare
Part A or Part B entitlement date. The APP DATE field allows
access to prior eligibility information related to:

Medicare Secondary Payer (MSP) records

Hospital/SNF stays

Home health prospective payment system (HH PPS) episodes

Part B deductible

Therapy cap
Additional information about the APP DATE field can be found
under the heading “Information about the APP DATE Field” found
later in this section.
REASON CODE
RESPONSE CODE

Reason for the inquiry:
1 – Status Inquiry – Default
Indicates whether the inquiry is an actual test or CWF test inquiry:
P – Production – Default
The example below illustrates how the CWF Part A Eligibility System screen looks after
the information is completed, but before the Enter key is pressed.
ELGA
CWF PART A ELIGIBILITY SYSTEM
ELGASAT1
04/05/2004 08:26:16
INQUIRY BY PROVIDERS
ENTER THE FOLLOWING FIELDS:
HIC NUMBER
: 123456789A
SURNAME
: SMITH
INITIAL
: J
DATE OF BIRTH : 01011931 (MMDDCCYY)
SEX CODE
: M
REQUESTOR ID
: 0010
INTER NO
:00010
NPI INDICATOR :
N-NPI or Blank
PROVIDER NO
: XXXXXX
HOST-ID
:
GL, GW, KS, MA, PA, NE, SE, SO, SW
APP DATE
:
(MMDDCCYY)
REASON CODE
: 1
RESPONSE CODE : P

If you receive an error message “Provider not on security file”, contact the Electronic
Data Interchange (EDI) department at 1 (866) 582-3253 and request your security be
modified to allow access to ELGA and ELGH.
Fiscal Intermediary Standard System Reference Guide
6
December 2013
Checking Beneficiary Eligibility
Medicare Administrative Contractor, Cahaba Government Benefits Administrators®, LLC
(Cahaba GBA)
Information about the HOST ID Field
The HOST ID field is related to different CWF host sites where beneficiary records are stored.
Records are stored based on the location where the beneficiary’s Social Security Number was
issued. There are nine host sites as identified in the following table.
GL – Great Lakes
 Illinois
 Michigan
 Minnesota
 Wisconsin
MA – Mid-Atlantic
GW – Great
 Idaho
 Iowa
 Kansas
 Missouri
 Montana
 Nebraska
 North Dakota
 Oregon
 South Dakota
 Utah
 Washington
 Wyoming
PA – Pacific
 Alaska
 Arizona
 California
 Hawaii
 Nevada
SO – South
 Florida
 Georgia
KS – Keystone
 Delaware
 New Jersey
 New York
 Pennsylvania
NE – Northeast
 Connecticut
 Maine
 Massachusetts
 New Hampshire
 Rhode Island
 Vermont
SW – Southwest
 Arkansas
 Colorado
 Louisiana
 New Mexico
 Oklahoma
 Texas






Indiana
Maryland
Ohio
Virginia
West Virginia
SE – Southeast
 Alabama
 Kentucky
 Mississippi
 North Carolina
 South Carolina
 Tennessee
If the beneficiary’s information cannot be found at the default host site, you may need to
look for the beneficiary’s information at another host site by entering a two-character
HOST-ID site (e.g., SO). You may need to try each of the different host sites before
finding the beneficiary’s information.
Fiscal Intermediary Standard System Reference Guide
7
December 2013
Checking Beneficiary Eligibility
Medicare Administrative Contractor, Cahaba Government Benefits Administrators®, LLC
(Cahaba GBA)
Information about the APP DATE Field
The ELGA and ELGH screens display the most current eligibility information. When this field
is left blank, it defaults to the current date, and data applicable to that date will appear; however,
by typing a date in the APP DATE field you can access prior eligibility information related to:





Medicare Secondary Payer (MSP) records
Hospital/SNF stays
Home health prospective payment system (HH PPS) episodes
Part B deductible
Therapy cap
To Access Prior:
MSP Records
Action:
Type the beneficiary’s date of admission to your facility or the
date services were provided by your facility.
To access prior MSP records, type the beneficiary’s Medicare Part
A or Part B effective date in the APP DATE field.
If the beneficiary has one or more MSP records, the information
will appear beginning on ELGA screen page 09. One additional
page will display for each MSP record that exist.
ELGH displays limited MSP information on screen page 04.
Hospital/SNF Stay
Type the beneficiary’s date of admission to your facility or the
date services were provided by your facility.
Screen page 01 of ELGA displays the most recent hospital/SNF
stay based on the APP DATE entered.
For the earliest hospital/SNF stay, type the beneficiary’s Medicare
Part A or Part B effective date in the APP DATE field. To find if
additional hospital/SNF stays occurred, type the date that follows
the DOLBA date of the earliest hospital stay in the APP DATE
field.
Note: The information for the most current inpatient stay may not
be available if the hospital/SNF has not submitted their billing to
Medicare.
Fiscal Intermediary Standard System Reference Guide
8
December 2013
Checking Beneficiary Eligibility
Medicare Administrative Contractor, Cahaba Government Benefits Administrators®, LLC
(Cahaba GBA)
To Access Prior:
HH PPS Episodes
Action:
Type the beneficiary’s date of admission to your facility or the
date services were provided by your facility. In certain instances,
it may be necessary to enter a date that is one calendar day prior to
your date of admission or dates of service.
Screen page 03 of ELGH displays the two most recent HH PPS
episodes based on the APP DATE entered. Screen page 04 of
ELGA displays similar information.
Part B deductible
Therapy Cap
Medicare Advantage
Plans
To find if prior HH PPS episodes exist, type the date that is prior
to the START DATE of the earliest episode listed.
Type the beneficiary’s date of admission to your facility or the
date services were provided by your facility.
Screen page 01 of ELGH or ELGA will provide the Part B
deductible year and deductible amount remaining based on the
APP DATE entered.
Type the beneficiary’s date of admission to your facility or the
date services were provided by your facility.
Screen page 01 of ELGA will provide the therapy cap amount
remaining for the year based on the APP DATE entered.
Type the beneficiary’s date of admission to your facility or the
date services were provided by your facility.
To display prior MA plan information on screen page 05 of ELGH
and screen page 01 of ELGA, the date entered in the APP DATE
field must match the MA enrollment date, termination date, or be
within the enrollment and termination date. Therefore, home
health providers may need to enter a date for the 60 day episode
period to determine if the beneficiary was enrolled in a MA plan
during the home health episode.
Fiscal Intermediary Standard System Reference Guide
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December 2013
Checking Beneficiary Eligibility
Medicare Administrative Contractor, Cahaba Government Benefits Administrators®, LLC
(Cahaba GBA)
4.
Once you have keyed the information on the CWF Part A Eligibility System screen, press
Enter. The system will indicate that it’s searching for the record.

If the message BENE-ERROR, BENEFICIARY RECORD NOT FOUND displays, verify the
information that was entered. There may be a data entry error preventing the system from
finding the beneficiary’s record. You may also want to enter a specific HOST ID.

If a message appears containing the phrase TNIF (True Not in File), the eligibility file is
being updated and this update may prevent you from being able to access the eligibility file
for a short period of time. Try accessing the file at a later time.

If the message Following Fields in Error – Correct and Resubmit displays, not all of the
required information is keyed or the information keyed is invalid. The message will also
identify which field is in error.
5.
When the information is entered accurately and the record is located at the host site, the
first page of the beneficiary’s eligibility record will display on your screen.

The eligibility record will have several pages of information. Use your F8 key to move
forward through the beneficiary eligibility pages. Use your F7 key to move back.
6.
If you want to look up another beneficiary’s eligibility information or need to enter an APP
DATE, press F1 from any of the CWF inquiry pages, and you will return to the CWF Part
A Eligibility System screen.
7.
When you are finished viewing the record, press F3. You will return to a blank screen.
You may type FSS0 to access FISS. To terminate the session, follow the steps below
a. Type cesf logoff and press ENTER.
b. The “TPX Menu” screen displays.
c. Type ‘/k’ in the ‘Command===>’ field and press ENTER.
d. Press F3 again and then press Enter.
d. Close your browser and disconnect from the Cahaba GBA system.
ELGA/ELGH Screen Examples and Field Descriptions
Field descriptions follow each set of screen examples.

All dates shown on the ELGA/ELGH screens are in MMDDCCYY format unless
otherwise noted.
Fiscal Intermediary Standard System Reference Guide
10
December 2013
Checking Beneficiary Eligibility
Medicare Administrative Contractor, Cahaba Government Benefits Administrators®, LLC
(Cahaba GBA)
ELGA Screen Page 01—Beneficiary Information (Beneficiary Entitlement, Hospital
and SNF Days, Medicare Advantage Plan Information)
ELGA
MM/DD/CCYY
CWF
HH:MM:SS
IP-REC CN
PN
DISP-CODE
CORRECT CN
PART A ELIGIBILITY SYSTEM
BENEFICIARY INFORMATION
NM
IT
APP
MSG
DED-TBM
IT
PHYS THER
TBM
PSYC
FULL-NAME
PLAN-TYPE
ESRD: CODE-1
EFF DATE
PF1=INQ SCREEN
PF3/CLEAR=END
SX
INT
REQ
A-ENT
A-TRM
B-ENT
DOD
LRSV
LPSY
DAYS LEFT FULL-HOSP CO-HOSP FULL-SNF CO-SNF
CURRENT
PARTB YR
DB
REAS
NM
ELGACRO
PAGE 01 OF 09
CURR-ID
CODE-2
DB
SX
B-TRM
IP-DED
DOEBA
DOLBA
OCC THER
TBM
OPT
ENR
EFF DATE
TERM
PF8=NEXT
ELGA Screen Page 01 Field Descriptions
LINE 1
IP-REC
For intermediary use only.
CN
The beneficiary’s Health Insurance Claim (HIC) number as entered on
the CWF Part A Eligibility System screen.
NM
The beneficiary’s last name as entered on the CWF Part A Eligibility
System screen.
IT
The first letter of beneficiary’s first name as entered on the CWF Part A
Eligibility System screen.
DB
The beneficiary’s date of birth as entered on the CWF Part A Eligibility
System screen.
SX
The beneficiary’s gender as entered on the CWF Part A Eligibility
System screen.
INT
The Medicare intermediary number as entered on the CWF Part A
Eligibility System screen.
Fiscal Intermediary Standard System Reference Guide
11
December 2013
Checking Beneficiary Eligibility
Medicare Administrative Contractor, Cahaba Government Benefits Administrators®, LLC
(Cahaba GBA)
LINE 2
PN
Your facility’s Medicare provider number as entered on the CWF Part A
Eligibility System screen.
APP
The date as entered in the APP DATE field on the CWF Part A
Eligibility System screen. If APP DATE field is left blank, this field will
be blank.
REAS
The reason for this inquiry as entered on the CWF Part A Eligibility
System screen. Valid codes:
1 – Status Inquiry (default);
2 – Inquiry relating to an admission.
REQ
The requester ID as entered on the CWF Part A Eligibility System screen
(0010).
LINE 3
DISP-CODE
Disposition Code: (This field only displays when the following codes
apply.)
01 – Part A Inquiry approved; beneficiary has never used Part A services
02 – Part A Inquiry approved: beneficiary has had some prior Part A
utilization
03 – Part A Inquiry rejected
05 – Applicable service date; DOD
20 – Qualified approval, may require further investigation
25 – Qualified approval. According to CMS’s records, this inquiry
begins a new benefit period
50 – Not in file
51 – Not in file on CMS Batch System
52 – Master Record housed at another CABLE site
55 – Does not match a Master Record
60 – Input/Output error on Date Base
61 – Cross Reference Data Base Problem
MSG
The description of the disposition code (DISP CODE). (This field only
displays when one of the DISP-CODEs listed above applies.)
Information in the following fields will only display if the data entered
on the CWF Part A Eligibility System screen was incorrect or has been
updated. When submitting claims to Medicare, use the information as it
appears in these fields to avoid claim submission errors.
LINE 4
CORRECT CN
Corrected claim number.
NM
Corrected name.
IT
Corrected initial.
Fiscal Intermediary Standard System Reference Guide
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December 2013
Checking Beneficiary Eligibility
Medicare Administrative Contractor, Cahaba Government Benefits Administrators®, LLC
(Cahaba GBA)
DB
Corrected date of birth.
SX
Corrected sex code.
LINE 5
A-ENT
The beneficiary’s date of entitlement to Medicare Part A benefits.
A-TRM
The beneficiary’s date of termination from Medicare Part A benefits.
B-ENT
The beneficiary’s date of entitlement to Medicare Part B benefits.
B-TRM
The beneficiary’s date of termination from Medicare Part B benefits.
LINE 6
DOD
Date of death of the beneficiary.
LRSV
Lifetime Reserve. Number of lifetime reserve days remaining.
LPSY
Lifetime Psychiatric. Number of psychiatric days remaining.
LINE 7 THROUGH 8
Line 7 contains the title heading for the information shown in line 8.
Line 8 displays current benefit information.
FULL-HOSP
The full hospital inpatient days remaining in the current benefit period.
CO-HOSP
The hospital inpatient coinsurance days remaining in the current benefit
period.
FULL-SNF
The full skilled nursing facility (SNF) days remaining in the current
benefit period.
CO-SNF
The SNF coinsurance days remaining in the current benefit period.
IP-DED
The amount of inpatient deductible remaining to be met.
DOEBA
The date of earliest billing action for an inpatient spell of illness in the
current benefit period.
DOLBA
The date of the latest billing action for an inpatient spell of illness in the
current benefit period.
LINE 9
PART B YR
Most recent Part B year (CCYYMMDD).
DED-TBM
The amount of Part B cash deductible remaining to be met for the year.
PSYC
The psychiatric deductible used for the year.
PHYS THER
TBM
The physical therapy and speech-language pathology (combined) cap
amount remaining in the Part B year.
OCC THER TBM
The occupational therapy cap amount remaining in the Part B year.
Fiscal Intermediary Standard System Reference Guide
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December 2013
Checking Beneficiary Eligibility
Medicare Administrative Contractor, Cahaba Government Benefits Administrators®, LLC
(Cahaba GBA)
LINE 10
FULL-NAME
The beneficiary’s full name as it appears on the Common Working File
(CWF) master record. When submitting claims to Medicare, use the full
name as it appears in this field to avoid claim submission errors.
LINE 11
PLAN-TYPE
CURR ID
OPT
This field provides the type of Medicare Advantage plan. Valid values
are:
 HMO (Health Maintenance Organization)
 PPO (Preferred Provider Organization)
 FFS Demo (Fee-for-Service Demonstration)
 Indemnity
 POS (Point of Sale)
The Medicare Advantage plan (HMO) identification code (5-digits):
1st digit – ‘H’ or 1-9
2nd and 3rd digit – State Code
4th and 5th digit – Medicare Advantage plan number within the State
The Medicare Advantage plan (Medicare HMO) Option Code. Describes
the beneficiary’s relationship with the Medicare Advantage plan. Valid
codes are:
ENR
1 – Intermediary processes all (Part A and Part B) provider bills
(unrestricted). Submit your claim to the intermediary.
2 – HMO processes directly provided services and arranged services.
Intermediary processes all others (unrestricted).
A – Intermediary processes all (Part A and Part B) provider bills
(restricted).
B – HMO to processes only bills for directly provided services
(restricted); intermediary to process all other bills.
C – HMO to process all bills (restricted). Submit your claim to the
Medicare Advantage plan (Medicare HMO).
The Medicare Advantage plan (Medicare HMO) enrollment date.
TERM
The Medicare Advantage plan (Medicare HMO) termination date.

If the MA plan listed on this screen impacts your dates of service, we encourage providers
to verify this information with the beneficiary. If the MA plan election listed is correct,
providers must look to the MA plan for reimbursement and a claim should not be submitted to
Cahaba GBA. If the MA plan election is listed in error, a claim should not be submitted until
the beneficiary’s record has been updated. Providers are also encouraged to use ELGA page
01 and page 02 to determine if the beneficiary has elected hospice and has an MA plan, in
which case, services are billed as usual to the traditional Medicare contractor.
Fiscal Intermediary Standard System Reference Guide
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December 2013
Checking Beneficiary Eligibility
Medicare Administrative Contractor, Cahaba Government Benefits Administrators®, LLC
(Cahaba GBA)
Access the following link from the CMS Web site to determine which Medicare Advantage
(MA) plan is associated with the identification code and how to contact the plan to submit
services for payment, when appropriate.
http://www.cms.hhs.gov/MCRAdvPartDEnrolData/PDMCPDO/list.asp
LINE 12
ESRD: – CODE-1
The End Stage Renal Disease (ESRD) method of reimbursement
(Method 1 or Method 2).
EFF DATE
The End Stage Renal Disease method of reimbursement effective date.
CODE-2
The End Stage Renal Disease method of reimbursement (Method 1 or
Method 2).
EFF DATE
The End Stage Renal Disease method of reimbursement effective date.
Fiscal Intermediary Standard System Reference Guide
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December 2013
Checking Beneficiary Eligibility
Medicare Administrative Contractor, Cahaba Government Benefits Administrators®, LLC
(Cahaba GBA)
ELGA Screen Page 02—Hospice Information
ELGA
MM/DD/CCYY
IP-REC
CWF
HH:MM:SS
PART A ELIGIBILITY SYSTEM
HOSPICE INFORMATION
CN
NM
PAP:
IMMUNO/TRANS:
PAP DATE:
TRANS IND:
HOSPICE
PERIOD
IT
DB
ELGACRO
PAGE 02 OF 09
SX
INT
DISCHARGE DATE:
PERIOD
PERIOD
PERIOD
PERIOD
START DATE
TERM DATE
REVOC IND
PF1=INQ SCREEN
PF3/CLEAR=END
PF7=PREV
PF8=NEXT
ELGA Screen Page 02 Field Descriptions
LINE 1
Line 1 information is carried over from the ELGA screen page 01. Refer to the “ELGA
Screen Page 01 Field Descriptions” for information about these fields.
LINE 2
The beneficiary’s Pap Risk indicator. Valid values are:
PAP
H
L
High risk
Low risk
The date of the beneficiary’s last PAP smear examination.
PAP DATE
LINE 3
IMMUNO/TRANS
Line 3 provides immunosuppressive/transplant information.
TRANS IND
This identifies whether the beneficiary has received a Medicare
covered transplant. Valid codes are:
1
2
B
H
I
K
L
Allograft bone marrow – transplant from another person
Autograft bone marrow – transplant from beneficiary
Lung transplant
Heart transplant
Intestinal transplant
Kidney transplant
Liver transplant
Fiscal Intermediary Standard System Reference Guide
16
December 2013
Checking Beneficiary Eligibility
Medicare Administrative Contractor, Cahaba Government Benefits Administrators®, LLC
(Cahaba GBA)
DISCHARGE DATE
LINE 4
HOSPICE PERIOD
Date of discharge hospital following transplant.
The title heading for information shown in lines 4 through 6 for up
to four hospice periods.
Indicates the five most recent hospice periods. The most recent
appears to the right.
LINE 5 THROUGH 6
START DATE
Start date of the hospice period.
TERM DATE
Termination date of the hospice period.
REVOC IND
A revocation indicator of “1” will display for the benefit period when
the beneficiary has revoked or been discharged from the hospice
benefit.
If a “1” does not appear, the beneficiary is still under the hospice
benefit. Any non-hospice claims submitted for services related to the
terminal diagnosis will be rejected.
Fiscal Intermediary Standard System Reference Guide
17
December 2013
Checking Beneficiary Eligibility
Medicare Administrative Contractor, Cahaba Government Benefits Administrators®, LLC
(Cahaba GBA)
ELGA Screen Page 03 (Home Health Benefit Periods)
Note: This screen should not be used to determine a beneficiary’s status in a home health
episode. (See “ELGA Screen Page 04” below for home health episode information.)
ELGA
MM/DD/CCYY
IP-REC
CWF
HH:MM:SS
CN
EARLIEST
BILLING DATE
PF1-INQ SCREEN
PART A ELIGIBILITY SYSTEM
HOME HEALTH BENEFIT PERIODS
NM
LATEST
BILLING DATE
PF3/CLEAR=END
IT
DB
SX
PART A VISITS
REMAINING
PF7-PREV
ELGACRO
PAGE 03 of ##
INT
PART B VISITS
APPLIED
PF8=NEXT
ELGA Screen Page 03 Field Descriptions
LINE 1
Line 1 information is carried over from the ELGA screen page 01. Refer to the “ELGA
Screen Page 01 Field Descriptions” for information about these fields.
LINE 2
EARLIEST
BILLING DATE
The earliest home health billing date.
LATEST BILLING
DATE
The latest home health billing date.
PART A VISITS
REMAINING
The remaining Part A visits.
PART B VISITS
APPLIED
The Part B visits that have been applied.
ELGA Screen Page 04, (Home Health PPS Episodes)
Note: This screen will display the two most recent home health PPS episodes based on the APP
DATE entered in the CWF Part A Eligibility System screen.
Fiscal Intermediary Standard System Reference Guide
18
December 2013
Checking Beneficiary Eligibility
Medicare Administrative Contractor, Cahaba Government Benefits Administrators®, LLC
(Cahaba GBA)
ELGA
MM/DD/CCYY
IP-REC
CWF
HH:MM:SS
CN
PART A ELIGIBILITY SYSTEM
HOME HEALTH PPS EPISODES
NM
EPISODE
START
EPISODE
END
PF1-INQ SCREEN
PF3/CLEAR=END
IT
DB
ELGACRO
PAGE 04 of 09
SX
DOEBA
PF7-PREV
INT
DOLBA
PF8=NEXT
ELGA Screen Page 04 Field Descriptions
LINE 1
Line 1 information is carried over from the ELGA screen page 01. Refer to the “ELGA
Screen Page 01 Field Descriptions” for information about these fields.
LINE 2
EPISODE START
The first day of the 60-day Home Health Prospective Payment System
(HH PPS) episode. (Two most recent home health episodes.)
EPISODE END
The last day of the 60-day HH PPS episode. (Two most recent home
health episodes.)
DOEBA
Date of Earliest Billing Action (DOEBA). This is the date of the first
billable visit in the home health episode.
DOLBA
Date of Latest Billing Action (DOLBA). This is the date of the last
billable visit in the home health episode.

This screen displays the two most recent HH PPS episodes. The most recent episode will
appear on the top line. To determine if prior episodes exist, make a note of the earliest
episode start date and press F1 to return to the CWF Part A Eligibility System screen.
Ensure that all required fields are complete. Tab to the APP DATE field. Enter a date that
is one day prior to the earliest episode start date. For example, if the earliest episode start
date appeared as 05172007, enter 05162007 in the APP DATE field and press Enter.
ELGA Page 01 appears. Use your F8 key to page forward to ELGA Page 04. The two
most recent HH PPS episodes, if there are any, will display based on the APP DATE
entered. To see if additional episodes prior to the start date of these episodes exist, repeat
the process by noting the earliest episode start date, pressing F1, and entering a date that is
one day prior to the earliest episode start date in the APP DATE field.
Fiscal Intermediary Standard System Reference Guide
19
December 2013
Checking Beneficiary Eligibility
Medicare Administrative Contractor, Cahaba Government Benefits Administrators®, LLC
(Cahaba GBA)
ELGA Screen Page 05 (Screening Information)
ELGA
MM/DD/CCYY
CWF
HH:MM:SS
IP-REC
CN
HCPCS
CODE
PART A ELIGIBILITY SYSTEM
SCREENING INFORMATION
NM
IT
TECH/
PROF
PF1-INQ SCREEN
DB
ELGACRO
PAGE 05 of 09
SX
INT
RECENT DATES OF SERVICE
PF3/CLEAR=END
PF7-PREV
PF8=NEXT
ELGA Screen Page 05 Field Descriptions
LINE 1
Line 1 information is carried over from the ELGA screen page 01. Refer to the
“ELGA Screen Page 01 Field Descriptions” for information about these fields.
LINE 2
HCPCS CODE
The HCPCS code for the screening service provided to this
beneficiary.
TECH/PROF
Indicates whether the technical or professional component was
billed. Valid entries:
26 – professional
TC – technical
RECENT DATES OF
SERVICE
The three most recent dates of service provided for each screening
service HCPCS code listed.
ELGA Screen Page 06 (Next Eligible Date)
ELGA
MM/DD/CCYY
CWF
HH:MM:SS
PART A
ELIGIBILITY SYSTEM
NEXT ELIGIBLE DATE
IP-REC CN 112233444A
NM SMITH
IT
PREVENTIVE SERVICE
TECH DTE PROF DTE |
MMDDCCYY MMDDCCYY |
CARDIOVASC (80061)
01012005 01012005 |
CARDIOVASC (82465)
01012005 01012005 |
CARDIOVASC (82718)
01012005 01012005 |
CARDIOVASC (84478)
01012005 01012005 |
COLORECTAL (G0104)
09011998 09011998 |
COLORECTAL (G0105)
09011998 09011998 |
COLORECTAL (G0106)
09011998 09011998 |
COLORECTAL (G0120)
09011998 09011998 |
COLORECTAL (G0121)
07012001 07012001 |
FOB TEST
(G0107)
HCPCTERM HCPCTERM |
FOB TEST
(G0328)
00000000 00000000 |
ELGACRO
PAGE 06 OF 09
A
DB xxxx1933
SX M
INT 00011
PREVENTIVE SERVICE
TECH DTE PROF DTE
MMDDCCYY MMDDCCYY
PCB EXAM
(G0101)
GDRNOELG GDRNOELG
PP VACCINE (90732)
VACCINTD VACCINTD
PROSTATE
(G0102)
01012000 01012000
PROSTATE
(G0103)
01012000 01012000
PAP TEST
(Q0091)
GDRNOELG GDRNOELG
DIABETES
(82947)
01012005 01012005
DIABETES
(82950)
01012005 01012005
DIABETES
(82951)
01012005 01012005
GLAU (G0117,G0118)
01012002 01012002
MAMM (G0202,G0203)
GDRNOELG GDRNOELG
MAMM
(76092)
GDRNOELG GDRNOELG
Fiscal Intermediary Standard System Reference Guide
20
December 2013
Checking Beneficiary Eligibility
Medicare Administrative Contractor, Cahaba Government Benefits Administrators®, LLC
(Cahaba GBA)
FOB
IPP
IPP
IPP
IPP
TEST
EXAM
EXAM
EXAM
EXAM
(82270)
(G0344)
(G0366)
(G0367)
(G0368)
PF1=INQ SCREEN
01012007
SRVNOELG
SRVNOELG
SRVNOELG
00000000
01012007
SRVNOELG
SRVNOELG
00000000
SRVNOELG
PF3/CLEAR=END
| MAMM
(77057)
| PAPT (P3000,G0123,
|
G0143,G0144,
|
G0145,G0147,
|
G0148)
PF7=PREV
GDRNOELG GDRNOELG
GDRNOELG GDRNOELG
PF8=NEXT
ELGA Screen Page 06 Field Descriptions
LINE 1
Line 1 information is carried over from the ELGA screen page 01. Refer to the
“ELGA Screen Page 01 Field Descriptions” for information about these fields.
LINE 2
PREVENTIVE
SERVICE
The abbreviation of each preventive service and the associated HCPCS
codes.
Preventive Services
Abbreviation
Cardiovascular
CARDIOVASC
Colorectal
Fecal Occult Blood Test
PREVENTIVE
SERVICE
(continued)
HCPCS
80061, 82465, 83718,
84478
COLORECTAL G0104, G0105, G0106,
G0120, G0121
FOB TEST
G0328, 82270
Initial Preventive Physical
Exam
IPP EXAM
G0402, G0403, G0404,
G0405
Pelvic and Clinical Breast
Exam
PCB EXAM
G0101
Pneumococcal Pneumonia
PP VACCINE
90732, 90669, 90670,
G0009
Preventive Services
Abbreviation
HCPCS
Prostate (including separate next
eligible dates for digital rectal
examination)
PROSTATE
G0102, G0103
Pap Test
PAP TEST OR
PAPT
Diabetes
DIABETES
Q0091, P3000,
P3001, G0123,
G0124, G0141,
G0143, G0144,
G0145, G0147,
G0148
82947, 82950,
82951
Fiscal Intermediary Standard System Reference Guide
21
December 2013
Checking Beneficiary Eligibility
Medicare Administrative Contractor, Cahaba Government Benefits Administrators®, LLC
(Cahaba GBA)
TECH DTE
and
PROF DTE
Glaucoma
GLAU
G0117, G0118
Mammography
MAMM
77052, 77057,
G0202,
The next eligible technical and professional date the beneficiary can receive
that preventive service.
In the event, the beneficiary is not eligible for the preventive service, the
technical and professional date fields will display an abbreviated message
that explains why the beneficiary is not eligible. These abbreviated
messages are:
NOPTBENT
Beneficiary not entitled to Part B
RECEIVED
Beneficiary already received service
DODNOELG
Beneficiary not eligible due to date of death
GDRNOELG
Beneficiary not eligible due to gender
AGENOELG
Beneficiary not eligible due to age
SRVNOELG
Beneficiary not eligible for the service
VACCINTD
Beneficiary already vaccinated
00000000
Service not applicable
HCPCTERM
HCPCS code for the preventive service has been
terminated.
NOPTBENT or
PTB
Beneficiary does not have Medicare Part B or
beneficiary’s next eligible date is after their
Medicare Part B termination date
DODNOENT or
DOD
Next eligible date for the preventive service is after
the beneficiary’s date of death
It is important to keep in mind that the eligibility date is calculated based on claims payment
history. As claims are processed, the eligibility dates may change; therefore, it is important for
providers to check the eligibility status before providing a service.

The Centers for Medicare & Medicaid Services (CMS) has a variety of Medicare Learning
Network (MLN) products related to preventive services. These resources are available on
the CMS Web site at:
http://www.cms.hhs.gov/MLNProducts/35_PreventiveServices.asp#TopOfPage
Fiscal Intermediary Standard System Reference Guide
22
December 2013
Checking Beneficiary Eligibility
Medicare Administrative Contractor, Cahaba Government Benefits Administrators®, LLC
(Cahaba GBA)
ELGA Screen Page 07 (Next Eligible Date)
ELGA
MM/DD/CCYY
CWF
HH:MM:SS
PART A
ELIGIBILITY SYSTEM
NEXT ELIGIBLE DATE
ELGACRO
PAGE 07 OF 09
IP-REC CN 112233444A
NM SMITH
IT A
DB xxxx1933
SX M
INT 00011
PREVENTIVE SERVICE
TECH DTE PROF DTE | PREVENTIVE SERVICE
TECH DTE PROF DTE
MMDDCCYY MMDDCCYY |
MMDDCCYY MMDDCCYY
AAA
(G0389)
01012005 01012005 |
PF1=INQ SCREEN
PF3/CLEAR=END
PF7=PREV
PF8=NEXT
LINE 1
Line 1 information is carried over from the ELGA screen page 01. Refer to the
“ELGA Screen Page 01 Field Descriptions” for information about these fields.
LINE 2
PREVENTIVE
SERVICE
TECH DTE
The abbreviation of each preventive service and the associated HCPCS
codes.
Preventive Services
Abbreviation
HCPCS
Abdominal Aortic
Aneurysm
Initial Preventive Physical
Exam
AAA
G0389
IPP EXAM
G0402, G0403, G0404,
G0405
The next eligible technical and professional date the beneficiary can receive
that preventive service.
and
PROF DTE
In the event, the beneficiary is not eligible for the preventive service, the
technical and professional date fields will display an abbreviated message
that explains why the beneficiary is not eligible. These abbreviated
messages are:
NOPTBENT
RECEIVED
DODNOELG
GDRNOELG
AGENOELG
SRVNOELG
VACCINTD
00000000
HCPCTERM
Beneficiary not entitled to Part B
Beneficiary already received service
Beneficiary not eligible due to date of death
Beneficiary not eligible due to gender
Beneficiary not eligible due to age
Beneficiary not eligible for the service
Beneficiary already vaccinated
Service not applicable
HCPCS code for the preventive service has been
terminated.
Fiscal Intermediary Standard System Reference Guide
23
December 2013
Checking Beneficiary Eligibility
Medicare Administrative Contractor, Cahaba Government Benefits Administrators®, LLC
(Cahaba GBA)
NOPTBENT or
PTB
DODNOENT or
DOD
Beneficiary does not have Medicare Part B or
beneficiary’s next eligible date is after their
Medicare Part B termination date
Next eligible date for the preventive service is after
the beneficiary’s date of death
Fiscal Intermediary Standard System Reference Guide
24
December 2013
Checking Beneficiary Eligibility
Medicare Administrative Contractor, Cahaba Government Benefits Administrators®, LLC
(Cahaba GBA)
ELGA Screen Page 08 (Smoking Cessation)
ELGA
MM/DD/CCYY
IP-REC CN
CWF
HH:MM:SS
ELIGIBILITY SYSTEM
SMOKING CESSATION
IT
DB
NM
COUNSELING PERIOD:
TOTAL SESSIONS:
HCPCS
PART A
FROM
1
2
THRU
PF1=INQ SCREEN
3
PER
PF3/CLEAR=END
4
ELGACRO
PAGE 08 OF 09
SX
INT
5
QT
TP
PF7=PREV
HCPCS
FROM
THRU
PER QT TP
PF8=NEXT
ELGA Screen Page 08 Field Description:
LINE 1
Line 1 information is carried over from the ELGA screen page 01. Refer to the “ELGA
Screen Page 01 Field Descriptions” for information about these fields.
LINE 2
TOTAL
SESSIONS
The total number of sessions per counseling period.
LINE 3
HCPCS
FROM
The HCPCS code identifying the level of smoking and tobacco-use cessation
counseling.
G0436 – Smoking and tobacco-use cessation counseling visit; intermediate,
greater than 3 minutes up to 10 minutes
G0437 – Smoking and tobacco-use cessation counseling visit; intensive,
greater than 10 minutes
From date of service in MM/DD/CCYY format.
THRU
Through date of service in MM/DD/CCYY format.
PER
Period number.
QT
Quantity.
TP
Claim type.
Fiscal Intermediary Standard System Reference Guide
25
December 2013
Checking Beneficiary Eligibility
Medicare Administrative Contractor, Cahaba Government Benefits Administrators®, LLC
(Cahaba GBA)
ELGA Screen Page 09 (Medicare Secondary Payer (MSP) Information)
Note: If MSP information is not applicable to the beneficiary, page 09 will not display.
Additional pages, beyond page 09, will display if more than one MSP record exists.
This page displays information only when the insurance is primary to Medicare. Supplemental
insurer information (insurance which is secondary to Medicare), such as Medigap and Medicaid,
will not appear on these screens. For Medicare Advantage plan (Medicare HMO) information,
refer to “ELGA Screen Page 01”.
ELGA
MM/DD/CCYY
IP-REC
CWF
HH:MM:SS
PART A ELIGIBILITY SYSTEM
MSP INFORMATION
CN
NM
IT
MSP CODE:
EFF DATE:
INSURER INFORMATION:
NAME
:
ADDRESS1 :
ADDRESS2 :
CITY
:
STATE
:
ZIP
:
POLICY NO :
PF1-INQ SCREEN
PF3/CLEAR=END
DB
ELGACRO
PAGE 09 of 09
SX
INT
TERM DATE:
PF7-PREV
PF8=NEXT
ELGA Screen Page 09 Field Descriptions
LINE 1
Line 1 information is carried over from the ELGA screen page 01. Refer to the
“ELGA Screen Page 01 Field Descriptions” for information about these fields.
LINE 2
MSP CODE
Valid MSP code indicator. Valid values are:
12 - Working Aged
13 - ESRD
14 - No-Fault
15 - Workers' Compensation
16 - Federal (Public Health)
41 - Black Lung
42 – Veterans
43 - Disabled
47 - Liability
Fiscal Intermediary Standard System Reference Guide
26
December 2013
Checking Beneficiary Eligibility
Medicare Administrative Contractor, Cahaba Government Benefits Administrators®, LLC
(Cahaba GBA)
EFF DATE
Effective date of the primary insurance.
TERM DATE
Termination date of the primary insurance.
LINE 3,4,5,6,7,8, AND 9
INSURER
INFORMATION
NAME – Primary Insurer’s Name
ADDRESS 1 and 2– Primary Insurer’s Address
CITY – Primary Insurer’s City
STATE – Primary Insurer’s State
ZIP – Primary Insurer’s Zip Code
POLICY NO – Policy Number of Primary Insurance
Fiscal Intermediary Standard System Reference Guide
27
December 2013
Checking Beneficiary Eligibility
Medicare Administrative Contractor, Cahaba Government Benefits Administrators®, LLC
(Cahaba GBA)
ELGH Screen Page 01 (Beneficiary Entitlement Information)
1.
To access ELGH, follow steps 1 through 7 under “Accessing ELGA and ELGH”. The
following screen illustrations and field descriptions apply to the ELGH screens.
ELGH
MM/DD/CCYY
CWF
HH:MM:SS
IP-REC
CN
PN
DISP-CODE
CORRECT CN
A-ENT
PARTB YR
FULL-NAME
PT TBM
PART A
ELIGIBILITY SYSTEM
BENEFICIARY INFORMATION
NM
IT
AP
MSG
DB
REAS
NM
A-TRM
DED-TBM
ELGHCRO
PAGE 01 of 09
SX
INT
REQ
IT
B-ENT
DB
B-TRM
SX
DOD
OT TBM
PF1-INQ PF3/CLEAR=END PF8=NEXT
ELGH Screen Page 01 Field Descriptions
LINE 1
IP-REC
For intermediary use only.
CN
The beneficiary’s Health Insurance Claim (HIC) Number as entered
on the CWF Part A Eligibility System screen.
NM
The beneficiary’s last name as entered on the CWF Part A Eligibility
System screen.
IT
The first initial of the beneficiary’s first name as entered on the CWF
Part A Eligibility System screen.
DB
The beneficiary’s date of birth as entered on the CWF Part A
Eligibility System screen.
SX
The beneficiary’s gender as entered on the CWF Part A Eligibility
System screen.
INT
The Medicare intermediary number as entered on the CWF Part A
Eligibility System screen.
LINE 2
PN
Your facility’s Medicare provider number as entered on the CWF Part
A Eligibility System screen.
Fiscal Intermediary Standard System Reference Guide
28
December 2013
Checking Beneficiary Eligibility
Medicare Administrative Contractor, Cahaba Government Benefits Administrators®, LLC
(Cahaba GBA)
AP
The date as entered in the APP DATE field on the CWF Part A
Eligibility System. If APP DATE field is left blank, this field will be
blank.
REAS
The reason for this inquiry as entered on the CWF Part A Eligibility
System. Valid codes:
1 – Status inquiry (default)
2 – Inquiry relating to an admission
REQ
The requestor ID as entered on the CWF Part A Eligibility System
(0010).
LINE 3
DISP CODE
Disposition Code: (This field only displays when the following codes
apply.)
01 – Part A Inquiry approved, beneficiary has never used Part A
services
02 – Part A Inquiry approved, beneficiary has had some prior Part A
utilization
03 – Part A inquiry rejected
05 – Applicable service date; DOD
20 – Qualified approval, may require further investigation
25 – Qualified approval, according to CMS records, this inquiry
begins a new benefit period
50 – Not in file
51 – Not in file on CMS system
52 – Master record housed at another site
55 – Does not match a master record
60 – Input/Output error on date base
61 – Cross reference data base problem
MSG
The description of the disposition (DISP CODE). (This field only
displays when one of the DISP CODEs listed above applies.)
LINE 4
Information in the following fields will only display if the data entered
on the CWF Part A Eligibility System screen was incorrect or has
been updated. When submitting claims to Medicare, use the
information as it appears in these fields to avoid claim submission
errors.
CORRECT CN
Corrected claim number.
NM
Corrected name.
IT
Corrected initial.
Fiscal Intermediary Standard System Reference Guide
29
December 2013
Checking Beneficiary Eligibility
Medicare Administrative Contractor, Cahaba Government Benefits Administrators®, LLC
(Cahaba GBA)
DB
Corrected date of birth.
SX
Corrected sex code.
LINE 5
A-ENT
The beneficiary’s date of entitlement to Medicare Part A benefits.
A-TRM
The beneficiary’s date of termination from Medicare Part A benefits.
B-ENT
The beneficiary’s date of entitlement to Medicare Part B benefits.
B-TRM
The beneficiary’s date of termination from Medicare Part B benefits.
DOD
Date of death of the beneficiary.
LINE 6
PART B YR
Most recent Part B year (CCYYMMDD).
DED-TBM
The amount of the Part B cash deductible remaining to be met for the
current year.
LINE 7
FULL-NAME
The beneficiary’s full name as it appears on the Common Working
File (CWF) master record.
LINE 8
PT TBM
The physical therapy and speech-language pathology (combined) cap
amount remaining in the Part B year.
OT TBM
The occupational therapy cap amount remaining in the Part B year.
Fiscal Intermediary Standard System Reference Guide
30
December 2013
Checking Beneficiary Eligibility
Medicare Administrative Contractor, Cahaba Government Benefits Administrators®, LLC
(Cahaba GBA)
ELGH Screen Page 02 (Home Health Benefit Information)
Note: This screen should not be used to determine a beneficiary’s status in a home health
episode. (See ELGH Screen Page 03 below for home health episode information.)
ELGH
MM/DD/CCYY
HH-REC
HH:MM:SS
CN
CWF PART A ELIGIBILITY SYSTEM
HOME HEALTH BENEFIT PERIODS
NM
EARLIEST
BILLING DATE
PF1-INQ SCREEN
PF3/CLEAR=END
IT
ELGHCRO
PAGE 02 of 09
DB
SX
LATEST
BILLING DATE
PF7-PREV
PF8=NEXT
ELGH Screen Page 02 Field Descriptions
LINE 1
Line 1 information is carried over from the ELGH screen page 01. Refer to the “ELGH
Screen Page 01 Field Descriptions” for information about these fields.
LINE 2
EARLIEST
BILLING DATE
The earliest home health billing date in the benefit period.
LATEST BILLING
DATE
The latest home health billing date in the benefit period.
Fiscal Intermediary Standard System Reference Guide
31
December 2013
Checking Beneficiary Eligibility
Medicare Administrative Contractor, Cahaba Government Benefits Administrators®, LLC
(Cahaba GBA)
ELGH Screen Page 03 (Home Health PPS Episodes)
Note: This screen will display the two most recent home health PPS episodes based on the APP
DATE entered in the CWF Part A Eligibility System screen.
ELGH
MM/DD/CCYY
HH-REC
CWF
HH:MM:SS
PART A
CN
ELIGIBILITY SYSTEM
HOME HEALTH PPS EPISODES
NM
START
DATE
END
DATE
PF1-INQ SCREEN
IT
INTER
NUM
PF3/CLEAR=END
PF7-PREV
ELGHCRO
PAGE 03 of 09
DB
PROV
NUM
SX
PATSTAT
CAN-IND
PF8=NEXT
ELGH Screen Page 03 Field Descriptions
LINE 1
Line 1 information is carried over from the ELGH screen page 01. Refer to the “ELGH
Screen Page 01 Field Descriptions” for information about these fields.
LINE 2
START DATE
The first day of the 60-day Home Health Prospective Payment System
(HH PPS) episode.
END DATE
The last day of the 60-day HH PPS episode.
INTER NUM
The intermediary number of the Medicare contractor that processed
the home health claim.
PROV NUM
The provider number of the home health agency providing home
health services.
PATSTAT
The patient status code submitted on the most recent home health
billing transaction (request for anticipated payment (RAP) or claim).
CAN-IND
Valid Cancel Indicator
0 = RAP not cancelled
1 = RAP cancelled
Fiscal Intermediary Standard System Reference Guide
32
December 2013
Checking Beneficiary Eligibility
Medicare Administrative Contractor, Cahaba Government Benefits Administrators®, LLC
(Cahaba GBA)
ELGH Screen Page 04 (Medicare Secondary Payer (MSP) Information)
This page displays information only when the insurance is primary to Medicare. Supplemental
insurer information (insurance which is secondary to Medicare), such as Medigap and Medicaid,
will not appear on these screens. For Medicare Advantage plan (Medicare HMO) information,
refer to “ELGH Screen Page 05”.
ELGH
MM/DD/CCYY
MSP-REC
REC
CWF PART A
ELIGIBILITY SYSTEM
HH:MM:SS
MSP INFORMATION
CN
NM
MSP CODE
PF1-INQ SCREEN
EFF DATE
PF3/CLEAR=END
IT
ELGHCRO
PAGE 04 of 09
DB
SX
TRM DATE
PF7-PREV
PF8=NEXT
ELGH Screen Page 04 Field Descriptions
LINE 1
Line 1 information is carried over from the ELGH screen page 01. Refer to the “ELGH
Screen Page 01 Field Descriptions” for information about these fields.
LINE 2
REC
The record number (line number) for MSP information. The
beneficiary may have more than one record.
MSP CODE
MSP code indicator. Valid values are:
12 = Working Aged
13 = ESRD
14 = Auto/Liability
15 = Worker’s Compensation
16 = Federal - Public Health
43 = Disabled
41 = Black Lung
42 = Veterans
47 = Any Liability
EFF DATE
Effective date of the primary insurance (MM/DD/CCYY).
TERM DATE
Termination date of the primary insurance (MM/DD/CCYY).
Fiscal Intermediary Standard System Reference Guide
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December 2013
Checking Beneficiary Eligibility
Medicare Administrative Contractor, Cahaba Government Benefits Administrators®, LLC
(Cahaba GBA)
ELGH Screen Page 05 (Medicare Advantage Plan Information)
ELGH
MM/DD/CCYY
HMO-REC
CWF PART A
HH:MM:SS
ELIGIBILITY SYSTEM
HMO INFORMATION
CN
NM
PLAN-TYPE
PLAN-ID
PF1-INQ SCREEN
PF3/CLEAR=END
IT
OPT
PF7-PREV
ELGHCRO
PAGE 05 of 09
DB
ENR-DATE
SX
TRM DATE
PF8=NEXT
ELGH Screen Page 05 Field Descriptions
LINE 1
Line 1 information is carried over from the ELGH screen page 01. Refer to the “ELGH
Screen Page 01 Field Descriptions” for information about these fields.
LINE 2
PLAN-TYPE
PLAN-ID
OPT
This field provides the type of Medicare Advantage plan. Valid
values are:
 HMO (Health Maintenance Organization)
 PPO (Preferred Provider Organization)
 FFS Demo (Fee-for-Service Demonstration)
 Indemnity
 POS (Point of Sale)
The Medicare Advantage plan (HMO) identification code (5-digits):
1st digit – ‘H’ or 1-9
2nd and 3rd digit – State Code
4th and 5th digit – Medicare Advantage plan number within the
State
Option Code. The Medicare Advantage (Medicare HMO) plan
identification code. Describes the beneficiary’s relationship with the
Medicare Advantage plan. Valid codes are:
1 – Intermediary processes all (Part A and Part B) provider bills
(unrestricted). Submit your claim to the intermediary.
2 – HMO processes directly provided services and arranged
services. Intermediary process all others (unrestricted).
A – Intermediary process all (Part A and Part B) provider bills
(restricted)
Fiscal Intermediary Standard System Reference Guide
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December 2013
Checking Beneficiary Eligibility
Medicare Administrative Contractor, Cahaba Government Benefits Administrators®, LLC
(Cahaba GBA)
B – HMO to processes only bills for directly provided services
(restricted); intermediary to process all other bills
OPT
(continued)
C – HMO to process all bills (restricted). Submit your claim to the
Medicare Advantage plan (Medicare HMO).
ENR-DATE
The Medicare Advantage Plan (Medicare HMO) effective date
(MMDDCCYY).
TERM DATE
The Medicare Advantage plan (Medicare HMO) termination date
(MMDDCCYY).

If the MA plan listed on this screen impacts your dates of service, we encourage providers
to verify this information with the beneficiary. If the MA plan election listed is correct,
providers must look to the MA plan for reimbursement and a claim should not be
submitted to Cahaba GBA. If the MA plan election is listed in error, a claim should not
be submitted until the beneficiary’s record has been updated. Providers are also
encouraged to use ELGH page 05 and page 08 to determine if the beneficiary has elected
hospice and has an MA plan, in which case, services are billed as usual to the traditional
Medicare contractor.
Access the following link from the CMS Web site to determine which Medicare Advantage
(MA) plan is associated with the identification code and how to contact the plan to submit
services for payment, when appropriate.
http://www.cms.hhs.gov/MCRAdvPartDEnrolData/PDMCPDO/list.asp
Fiscal Intermediary Standard System Reference Guide
35
December 2013
Checking Beneficiary Eligibility
Medicare Administrative Contractor, Cahaba Government Benefits Administrators®, LLC
(Cahaba GBA)
ELGH Screen Page 06 (Next Eligible Date)
ELGA
MM/DD/CCYY
CWF
HH:MM:SS
PART A
ELIGIBILITY SYSTEM
NEXT ELIGIBLE DATE
IP-REC CN 112233444A
NM SMITH
IT
PREVENTIVE SERVICE
TECH DTE PROF DTE |
MMDDCCYY MMDDCCYY |
CARDIOVASC (80061)
01012005 01012005 |
CARDIOVASC (82465)
01012005 01012005 |
CARDIOVASC (82718)
01012005 01012005 |
CARDIOVASC (84478)
01012005 01012005 |
COLORECTAL (G0104)
09011998 09011998 |
COLORECTAL (G0105)
09011998 09011998 |
COLORECTAL (G0106)
09011998 09011998 |
COLORECTAL (G0120)
09011998 09011998 |
COLORECTAL (G0121)
07012001 07012001 |
FOB TEST
(G0107)
HCPCTERM HCPCTERM |
FOB TEST
(G0328)
00000000 00000000 |
FOB TEST
(82270)
01012007 01012007 |
IPP EXAM
(G0344)
SRVNOELG SRVNOELG |
IPP EXAM
(G0366)
SRVNOELG SRVNOELG |
IPP EXAM
(G0367)
SRVNOELG 00000000 |
IPP EXAM
(G0368)
00000000 SRVNOELG |
PF1=INQ SCREEN
PF3/CLEAR=END
ELGACRO
PAGE 06 OF 09
A
DB xxxx1933
SX M
INT 00011
PREVENTIVE SERVICE
TECH DTE PROF DTE
MMDDCCYY MMDDCCYY
PCB EXAM
(G0101)
GDRNOELG GDRNOELG
PP VACCINE (90732)
VACCINTD VACCINTD
PROSTATE
(G0102)
01012000 01012000
PROSTATE
(G0103)
01012000 01012000
PAP TEST
(Q0091)
GDRNOELG GDRNOELG
DIABETES
(82947)
01012005 01012005
DIABETES
(82950)
01012005 01012005
DIABETES
(82951)
01012005 01012005
GLAU (G0117,G0118)
01012002 01012002
MAMM (G0202,G0203)
GDRNOELG GDRNOELG
MAMM
(76092)
GDRNOELG GDRNOELG
MAMM
(77057)
GDRNOELG GDRNOELG
PAPT (P3000,G0123,
GDRNOELG GDRNOELG
G0143,G0144,
G0145,G0147,
G0148)
PF7=PREV
PF8=NEXT
ELGH Screen Page 06 Field Descriptions
LINE 1
Line 1 information is carried over from the ELGH screen page 01. Refer to the “ELGH
Screen Page 01 Field Descriptions” for information about these fields.
LINE 2
PREVENTIVE
SERVICE
The abbreviation of each preventive service and the associated
HCPCS codes.
Preventive Services
Abbreviation
HCPCS
Cardiovascular
CARDIOVASC
Colorectal
COLORECTAL
Fecal Occult Blood
Test
FOB TEST
80061, 82465, 82718,
84478
G0104, G0105, G0106,
G0120, G0121,
G0107, G0328, 82270
Initial Preventive
Physical Exam
IPP EXAM
G0344, G0366, G0367,
G0368
Pelvic and Clinical
Breast Exam
PCB EXAM
G0101
Fiscal Intermediary Standard System Reference Guide
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December 2013
Checking Beneficiary Eligibility
Medicare Administrative Contractor, Cahaba Government Benefits Administrators®, LLC
(Cahaba GBA)
PREVENTIVE
SERVICE
(continued)
TECH DTE
and
PROF DTE
Preventive Services
Abbreviation
HCPCS
Pneumococcal
Pneumonia Vaccine
PP VACCINE
90732
Prostate (including
separate next eligible
dates for digital rectal
examination)
PROSTATE
G0102, G0103
Pap Test
PAP TEST OR
PAPT
Diabetes
DIABETES
Q0091, P3000, G0123,
G0143, G0144, G0145,
G0147, G0148
82947, 82950, 82951
Glaucoma
GLAU
G0117, G0118
Mammography
MAMM
76092, 77057, G0202,
G0203
The next eligible technical or professional date the beneficiary can
receive that preventive service.
In the event, the beneficiary is not eligible for the preventive service,
the technical and professional date fields will display an abbreviated
message that explains why the beneficiary is not eligible. These
abbreviated messages are:
NOPTBENT
Beneficiary not entitled to Part B
RECEIVED
Beneficiary already received service
DODNOELG
Beneficiary not eligible due to date of death
GDRNOELG
Beneficiary not eligible due to gender
AGENOELG
Beneficiary not eligible due to age
SRVNOELG
Beneficiary not eligible for the service
VACCINTD
Beneficiary already vaccinated
HCPCTERM
HCPCS code for the preventive services has
been terminated.
00000000
Service not applicable
NOPTBENT or
PTB
Beneficiary does not have Medicare Part B or
beneficiary’s next eligible date is after their
Medicare Part B termination date
DODNOENT or
DOD
Next eligible date for the preventive service is
after the beneficiary’s date of death
Fiscal Intermediary Standard System Reference Guide
37
December 2013
Checking Beneficiary Eligibility
Medicare Administrative Contractor, Cahaba Government Benefits Administrators®, LLC
(Cahaba GBA)
It is important to keep in mind that the eligibility date is calculated based on claims payment
history. As claims are processed, the eligibility dates may change; therefore, it is important for
providers to check the eligibility status before providing a service.

The Centers for Medicare & Medicaid Services (CMS) has a variety of Medicare Learning
Network (MLN) products related to preventive services. These resource are available on
the CMS Web site at:
http://www.cms.hhs.gov/MLNProducts/35_PreventiveServices.asp#TopOfPage
Fiscal Intermediary Standard System Reference Guide
38
December 2013
Checking Beneficiary Eligibility
Medicare Administrative Contractor, Cahaba Government Benefits Administrators®, LLC
(Cahaba GBA)
ELGH Screen Page 07 (Next Eligible Date)
ELGH
MM/DD/CCYY
CWF
HH:MM:SS
PART A
ELIGIBILITY SYSTEM
NEXT ELIGIBLE DATE
ELGACRO
PAGE 07 OF 09
IP-REC CN 112233444A
NM SMITH
IT A
DB xxxx1933
SX M
INT 00011
PREVENTIVE SERVICE
TECH DTE PROF DTE | PREVENTIVE SERVICE
TECH DTE PROF DTE
MMDDCCYY MMDDCCYY |
MMDDCCYY MMDDCCYY
AAA
(G0389)
01012005 01012005 |
PF1=INQ SCREEN
PF3/CLEAR=END
PF7=PREV
PF8=NEXT
LINE 1
Line 1 information is carried over from the ELGA screen page 01. Refer to the
“ELGA Screen Page 01 Field Descriptions” for information about these fields.
LINE 2
PREVENTIVE
SERVICE
The abbreviation of each preventive service and the associated
HCPCS codes.
Preventive Services
TECH DTE
and
PROF DTE
Abbreviation
HCPCS
Abdominal Aortic
AAA
G0389
Aneurysm
The next eligible technical or professional date the beneficiary can
receive that preventive service.
In the event, the beneficiary is not eligible for the preventive service,
the technical and professional date fields will display an abbreviated
message that explains why the beneficiary is not eligible. These
abbreviated messages are:
NOPTBENT
Beneficiary not entitled to Part B
RECEIVED
Beneficiary already received service
DODNOELG
Beneficiary not eligible due to date of death
GDRNOELG
Beneficiary not eligible due to gender
AGENOELG
Beneficiary not eligible due to age
SRVNOELG
Beneficiary not eligible for the service
VACCINTD
Beneficiary already vaccinated
00000000
Service not applicable
HCPCTERM
HCPCS code for the preventive service has been
terminated.
Fiscal Intermediary Standard System Reference Guide
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December 2013
Checking Beneficiary Eligibility
Medicare Administrative Contractor, Cahaba Government Benefits Administrators®, LLC
(Cahaba GBA)
TECH DTE
and
PROF DTE
(continued)
NOPTBENT
or PTB
Beneficiary does not have Medicare Part B or
beneficiary’s next eligible date is after their
Medicare Part B termination date
DODNOENT
or DOD
Next eligible date for the preventive service is after
the beneficiary’s date of death
Fiscal Intermediary Standard System Reference Guide
40
December 2013
Checking Beneficiary Eligibility
Medicare Administrative Contractor, Cahaba Government Benefits Administrators®, LLC
(Cahaba GBA)
ELGH Screen Page 08 (Smoking Cessation)
ELGA
MM/DD/CCYY
IP-REC CN
CWF
HH:MM:SS
ELIGIBILITY SYSTEM
SMOKING CESSATION
IT
DB
NM
COUNSELING PERIOD:
TOTAL SESSIONS:
HCPCS
PART A
FROM
1
2
THRU
PF1=INQ SCREEN
3
PER
PF3/CLEAR=END
4
ELGACRO
PAGE 08 OF 09
SX
INT
5
QT
TP
PF7=PREV
HCPCS
FROM
THRU
PER QT TP
PF8=NEXT
ELGA Screen Page 08 Field Description:
LINE 1
Line 1 information is carried over from the ELGH screen page 01. Refer to the “ELGH
Screen Page 01 Field Descriptions” for information about these fields.
LINE 2
TOTAL
SESSIONS
The total number of sessions per counseling period.
LINE 3
HCPCS
The HCPCS code identifying the level of smoking and tobacco-use
cessation counseling.
G0375 – Smoking and tobacco-use cessation counseling visit; intermediate,
greater than 3 minutes up to 10 minutes
G0376 – Smoking and tobacco-use cessation counseling visit; intensive,
greater than 10 minutes
FROM
From date of service in MM/DD/CCYY format.
THRU
Through date of service in MM/DD/CCYY format.
PER
Period number.
QT
Quantity.
TP
Claim type.
Fiscal Intermediary Standard System Reference Guide
41
December 2013
Checking Beneficiary Eligibility
Medicare Administrative Contractor, Cahaba Government Benefits Administrators®, LLC
(Cahaba GBA)
ELGH Screen Page 09 (Hospice Information)
ELGH
MM/DD/CCYY
HOS-REC
HOSPICE
CWF PART A ELIGIBILITY SYSTEM
HOSPICE INFORMATION
ELGHCRO
PAGE 09 of 09
HH:MM:SS
CN
NM
PERIOD
IT
PERIOD
DB
PERIOD
SX
PERIOD
START DATE
TERM DATE
PROVIDER NO
INTER NO
REVOC IND
PF1-INQ SCREEN
PF3/CLEAR=END
PF7-PREV
PF8=NEXT
ELGH Screen Page 09 Field Descriptions
LINE 1
Line 1 information is carried over from the ELGH screen page 01. Refer to the “ELGH
Screen Page 01 Field Descriptions” for information about these fields.
LINE 2
HOSPICE PERIODS
The title heading for information shown in lines 3 through 6.
Indicates the four most recent hospice periods. The most recent
appears on the left.
LINE 3 THROUGH 6
START DATE
The start date of the hospice benefit period.
TERM DATE
The termination date of the hospice benefit period.
PROVIDER NO
The provider number of the hospice facility providing hospice
services.
INTER NO
The intermediary number of the Medicare contractor that processed
the hospice claim.
REVOC IND
A revocation indicator of “1” will display for the benefit period when
the beneficiary has revoked or been discharged from the hospice
benefit.
If a “1” does not appear, the beneficiary is still under the hospice
benefit. Any non-hospice claims submitted for services related to the
terminal diagnosis will be rejected.
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December 2013