Eligibility Inquiry
The WCMBP system enables you to inquire about a claimant’s eligibility status by submitting information about the claimant on the Claimant Eligibility Inquiry page.
To access this page, use one of the following methods:
- From the Claimant tab menu, select Eligibility Inquiry.
- From the claimant’s Demographic and Case Detail page, select the Show menu and select Accepted Conditions from the drop-down.
- Portal Users Only: From the portal home page, select Eligibility Inquiry from the side menu.
Note: The Claimant Eligibility Inquiry page has two views depending on the radio button you select under the page title. The Non-Pharmacy Services button is the default selection and it displays the Eligibility for Non-Pharmacy Services view. The Accepted Conditions radio button, which applies only to DFEC, DEEOIC, and DLHWC claimants, switches the page to the Eligibility for Accepted Condition Services view.
Eligibility for Non-Pharmacy Services
Under the Eligibility for Non-Pharmacy Services section, enter the claimant data for the following fields and select Submit.
-
Provider ID
-
Program Code – Select DCMWC, DEEOIC, DFEC, or DLHWC from the drop-down list.
-
Case ID
-
Diagnosis Code – Enter at least one diagnosis code.
-
Procedure Code or Revenue Code – Enter if required by the Revenue/Procedure Code Matrix.
-
NDC Code
-
Date of Service
Note: For Portal users, the Provider ID, Program Code, and NDC Code fields are pre-filled. Enter your claimant data in the remaining fields.
After you select Submit, the WCMBP system displays the inquiry results on the Claimant Eligibility Inquiry Response page. The results on this page inform you of the claimant’s eligibility to receive treatment/services and the level of authorization for the treatment/services as indicated by the Authorization Level field.
Select Close to return to the previous page.
Eligibility for Accepted Conditions (DEEOIC, DFEC, DLHWC Only)
To inquire about accepted conditions for a DEEOIC, DFEC, or DLHWC claimant, from the Claimant Eligibility Inquiry page, select the Accepted Conditions radio button located below the page title. The page refreshes to the Eligibility for Accepted Condition Services view.
Enter the claimant data for the following fields and select Submit:
-
Case ID
-
Program Code – Select DEEOIC, DFEC, or DLHWC from the drop-down list.
-
Date of Service
Note: For Portal users, enter the date of service. The Case ID andProgram Code fields are pre-filled.
After you select Submit, the WCMBP system displays the inquiry results on the Claimant Accepted Conditions page. The results on this page tell you the level of authorization for the accepted condition as indicated by the Authorization Level field.
Select Close to return to the previous page.