When a caller reaches the GHI Medicare Interactive Voice Response unit he/she will be presented a list of menu options. Using a touch tone phone, please choose from the following menu:
| Menu |
Menu Option |
Description |
| Beneficiary Eligibility |
1 |
Receive Part B eligibility dates and HMO information |
| Claim Information |
2 |
Receive information on a specific claim for a given date of service including line items. |
| Duplicate Remittance |
3 |
Order a duplicate remittance to be mailed to your corespondance address |
| Deductible Status |
4 |
Receive a beneficiary's current and prior year deductible status |
| Pending Summary |
5 |
Receive a dollar amount of claims approved to pay |
| Procedure Pricing |
6 |
Receive information on current year pricing |
| Transfer to CSR |
7 |
Transfer to a Customer Service Representative |
Eligibility
The IVR will ask for the following information from the caller:
- Provider number
- Patient Medicare number (HIC)
- Patient date of birth
- Patient gender
- Patient surname and first name
The IVR will play back the following information to the caller:
- Patient Part A entitlement dates
- Patient Part B entitlement dates
- HMO information (no HMO, HMO restricted, HMO open)
- HMO entitlement dates
- HMO plan number
Claim Information
The IVR will ask for the following information from the caller:
- Provider number
- Patient Medicare number (HIC)
- Date of service
The IVR will play back the following information to the caller:
- Submitted amount
- Allowed amount
- Applied amount
- Paid amount
- Claim status (pending, processed)
If the claim was paid and finalized, the caller will be presented with the following options:
| Line item detail information |
3 |
| Order a duplicate remittance |
1 |
| Continue |
2 |
If the claim is pending, or the caller continues from the previous menu, he/she will be presented with this menu:
| Repeat information |
* |
| Another claim for the same date of service |
1 |
| Another claim for a different date of service |
2 |
| Another claim for a different Medicare number |
3 |
If the caller chooses to receive the line item details information, the following is presented:
- Date of service
- Procedure code
- Amount submitted
- Amount allowed
- Denial reason (if applicable)
Order a Duplicate Remittance
The IVR will ask for the following information from the caller:
- Provider number
- Patient Medicare number (HIC)
- Claim control number (ICN)
The IVR will play back the following information to the caller:
- If the remittance can be ordered, the IVR will give a confirmation
- If it cannot due to assignment, it will play back an appropriate message
Deductible Status
The IVR will ask for the following information from the caller:
- Provider number
- Patient Medicare number (HIC)
The IVR will play back the following information to the caller:
- Current year deductible
- Prior year deductible
Pending Summary
The IVR will ask for the following information from the caller:
- Provider number
The IVR will play back the following information to the caller:
- Dollar amount of approved-to-pay claims
Procedure Pricing
The IVR will ask for the following information from the caller:
- Provider number
- Place of service
- Procedure code
- Zip code
The IVR will play back the following information to the caller:
- Current year reasonable charge
Using the Keypad to Enter Letters
When prompted for a provider number, use the following technique for entering a letter.
Each key on a phone has corresponding letters. For example, the number 2 has letters A, B and C. When entering a letter in a provider number, press * then the key which contains the letter, then the position of the letter on the key, then the pound sign. For example, the letter H would be keyed as *-4-2-#. The letter H is on the 4 key in the second position.
When prompted for the last, first, and middle initial of a beneficiary, use the keypad to enter the number of the corresponding letter. You do not need to enter the position of the letter. For example, Doe, John would be entered as 3-6-3-5-6-4-6. |
