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Illinois Medicaid Patient Verification

HFS Medical Card - Eligibility Verification

Upon enrollment in one of the Department’s Medical Programs most participants will be issued a paper HFS Medical Card – HFS 469. Medical cards are issued annually and contain the names and Recipient Identification Number (RIN) of each individual on the case; however, the medical card is not proof of active medical eligibility. A family may receive more than one card in instances where the number of persons in the case is greater than the space available for printing on one card. Medical cards are issued when a:

    • Medical case is approved.
    • Person (s) is added to or deleted from the medical case.
    • Redetermination or renewal of eligibility is processed.
    • Person’s name or date of birth is corrected on a medical case.
    • Duplicate card is requested by the participant.

An HFS Medical Card – HFS 469 may be issued to a Qualified Medicare Beneficiary (QMB) who is not eligible for full medical benefits, but is eligible for Department consideration for payment of Medicare coinsurance and deductibles. The HFS Medical Card for this population is no longer marked with “QMB only.”

Participants in a case with Spenddown receive an HFS Medical Card – HFS 469 upon enrollment. The card will be issued regardless of the Spenddown being met or unmet.

Participants in the State Chronic Renal Disease Program, the State Sexual Assault Survivors Emergency Treatment Program and the State Hemophilia Program do not receive an HFS Medical Card.

Medical Eligibility Verification

As stated on the HFS Medical Card – HFS 469, the card does not guarantee eligibility or payment for services. Providers should verify eligibility even if the individual has a medical card, knows their Recipient Identification Number (RIN), or can give their Social Security Number and date of birth. In addition, providers are encouraged to ask for an additional piece of identification to verify the identity of the person presenting the card or providing the information. Providers may not charge participants to verify eligibility.

Medical cards that seem questionable (i.e., altered cards, cards containing handwritten entries, cards that do not follow the format of the HFS 469) should be investigated. If a provider suspects fraud or abuse regarding the use of a HFS Medical Card, the provider should call the Department’s Medicaid/Welfare Fraud Hotline, at 844-453-7283/844-ILFRAUD.

When information needs to be updated on a participant’s medical card, the participant should contact their local DHS FCRC, call the Change Report Hotline at 800-720-4166, or go online on the DHS website to update their information. A person who loses eligibility and later re-enrolls will be assigned the same Recipient Identification Number (RIN).

Participant eligibility can be verified using one of the following resources.

Medical Electronic Data Interchange (MEDI) Internet Site

The Medical Electronic Data Interchange (MEDI) website allows authorized users online access to Department information.

    • No charge to you or your authorized users to verify a participant’s eligibility.
    • No limit on the number of participant eligibility inquiries that can be made.
    • Participant eligibility verification available seven days a week 24-hours a day.
    • Participant eligibility inquiries can be made by using the:
      • Recipient Identification Number (RIN).
      • Participant’s first and last name (as it appears in the HFS data bases) and their date of birth.
      • Participant’s first and last name and Social Security Number.
      •  Participant’s Social Security Number.

Automated Voice Response System (AVRS) — 800-842-1461

    • No charge to you or your authorized users to verify a participant’s eligibility.
    • A limit of six (6) participant eligibility inquiries per phone call.
    • Participant eligibility verification available seven days a week, 24-hour a day.
    • Participant eligibility inquiries can be made by using the RIN and the date of service.

Recipient Eligibility Verification (REV) System

The Recipient Eligibility Verification (REV) system is an interactive electronic system that allows providers to verify a participant’s eligibility.

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