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Eligibility verification

1. Procedure performed by a provider or health facility of checking and confirming that a patient is a member of an insurance plan and that the member identification number is correct. 2. Process of an insurance company to validate that a patient is a member of a plan and the authorization of payment for a medical service before it is rendered. Also called insurance verification or verification .

eligibility—Medicare Part A

An individual is eligible for premium-free (no cost) Medicare Part A (hospital insurance) if he or she is 65 or older and receiving, or eligible for, retirement benefits from Social Security or the Railroad Retirement Board, or is younger than 65 and has received Railroad Retirement disability benefits for the prescribed time and meets the Social Security Act disability requirements, or had Medicare-covered government employment, or is younger than 65 and has end-stage renal disease (ESRD). If an individual is not eligible for premium-free Medicare Part A, he or she can buy Part A by paying monthly premium if he or she is 65 or older and enrolled in Part B, a resident of the United States, and either a citizen or an alien lawfully admitted for permanent residence who has lived in the United States continuously during the 5 years before the month in which they apply.

eligibility—Medicare Part B

An individual is automatically eligible for Part B if he or she is eligible for premium-free Part A. They are also eligible for Part B if they are not eligible for premium-free Part A but are age 65 or older and a resident of the United States or a citizen or an alien lawfully admitted for permanent residence. In this case, they must have lived in the United States continuously during the 5 years immediately before the month during which he or she enrolls in Part B.

Eligible complainants

Entities protected by FSA rules contained in Dispute resolution: Complaints Handling. They are: private individuals; a commercial customer with a group annual turnover below £1m; a charity with an annual income below £1m; and a trustee of a trust with a net asset value of less than £1m.