In December of 2005, we implemented a new Interactive Voice Response or Voice Recognition (IVR) system. This new IVR allows you to obtain information through speech interaction rather than touch tone. Some of the information available to you through our new IVR is claims status, eligibility records, and reimbursement checks information. Additionally the IVR is available in English and Spanish. When you call into our IVR you will be greeted by a pleasant automated voice which will instruct you on what information to speak to obtain data from our IVR. The below information will provide you with an overview of the new IVR options and provide you with additional facts that will help you to expedite your call.

To reach the Interactive Voice Recognition System, providers should call the following toll free number:

Rhode Island Part A 877-846-2819
Rhode Island Part B 877-846-2820

You will begin by hearing a female voice speaking "Hi thanks for calling your Medicare Part (A or B) Service System". You will then be given the option to obtain data in Spanish. The system automatically defaults to English if you do not choose the Spanish option. After that the system will ask you to hold while it accesses Medicare’s computers. You will hear a short moment of music and then you will be prompted to speak your National Provider Identifier (NPI). Once your NPI has been validated, you will be asked to speak your Provider Transaction Access Number (PTAN). The NPI and PTAN are used as authentication elements. You must speak your number; touch tone is not available at this time.

To use the IVR system, you must have a valid NPI and PTAN Number. Always use your Group NPI if you are associated with a group practice. To enter the number, you simply speak the number naturally.

Once your NPI and PTAN have been validated you will be given the following options to choose from the Main Menu: Claims Status, Eligibility Information, Reimbursement Checks Status and Other Options. When selecting Eligibility or Claims you will be ask for your patient’s Medicare number, please have that information available.

CLAIMS OPTION

You may say Claim for the status of a claim or claims.

You will then be asked for the Medicare number and date of service in question.

Once your information has been accepted. The IVR will speak back the total amount submitted, deductible applied, payment amount, check number, and allowed amount.

At this point you can request more detail on the claim by speaking More Detail. This feature will give you the date of service, medical procedure code, modifier, billed amount and approved amount or denial message.

After this you may say Repeat to repeat the claim information,

Or you can say Another Claim to receive data on another claim on same patient, a claim on a different patient, or to switch provider numbers to search for claims under another provider number.

Or speak I’m Done if you are finished.

This information can be accessed from 6:00 a.m. to 6:00 p.m. Monday through Friday.

ELIGIBILITY OPTION

You may say Eligibility to receive information on Part A and Part B entitlement, deductible information, and Medicare primary/secondary data, Health Maintenance Organizations on file, Home Health and Hospice information. When calling about eligibility you must be able to validate the following information about the Beneficiary:

Beneficiary’s first and last name
Beneficiary’s Health Insurance Claim (HIC) number
Beneficiary’s gender and Date of Birth

This information can be accessed from 6:00 a.m. to 6:00 p.m. Monday through Friday.

CHECKS OPTION

You may say Checks to get information on checks or a specific check. You may search by specific check number, a date or range of dates, or status.

You may say Number to receive information on a specific check number. You must have the check number for this search.

You may say Date to get information on a specific date or range of dates. You do not need the check number.

You may say Status to do a search by cleared status, outstanding status, stopped status or voided status.

This information can be accessed from 6:00 a.m. to 6:00 p.m. Monday through Friday.

OTHER OPTION

You may say Other Options to receive information on Remittance Notice Copies, Customer Service Numbers, Appeals Rights and Seminars.

This information is available 24 hours.

You may say Remittance Notice to learn how to obtain copies of your notice.

You may say Customer Service Number to receive information on how to speak with a customer service representative.

You may say Appeals to learn about the Medicare appeals process.

You may say Seminars to learn more about Medicare seminars or workshops in your area.

Once you have obtained your information, you may say Main Menu, to bring you back to the Main Menu. You must have entered a valid provider number to receive this information.

Helpful Hints

You must speak your information we are not programmed for touchtone at this time

You will need to have your provider information and patient information ready when calling. The system will not accept the Tax ID number or the UPIN number.

You cannot reach customer service through the IVR. You can get Customer Service Phone numbers and through the Main Menu’s other options.

Railroad Medicare Numbers have a prefix that begins with a letter. You will need to call Railroad Medicare at 877-288-7600.

Give the complete Medicare number, using the 9 numeric digits including the suffix.

When speaking an alpha character do not emphasis by speaking a descriptive word behind the character. (For Example "B as in Boat" or "A as in Apple"). This will confuse the IVR.

Speak naturally when giving information.

The IVR is sensitive to background noises and may interpret it as your response. The following situations will cause problems with your call: speaking to others in the office, laughing, coughing, sneezing and loud noises in the background.

Please listen to the system prompts very carefully. These prompts will let the caller know what the system is expecting to hear from the caller. Once you are familiar with the prompts you can barge ahead.

Our staff is working continuously to bring you improved and enhanced services through the new Interactive Voice Response System. We welcome your input and/or suggestions.