Medicare Eligibility Verification Software

Medicare eligibility verification software that delivers secure, 24/7 access to Medicare’s HETS database, enabling real-time detailed inquiries.

Eligibility Verification Medicare, Powered by the Inovalon ONE® Platform

Access critical eligibility information in real-time, from one tool, powered by a secure connection to Medicare HETS with benefits visibility up to four years in the past and four months ahead.


Get fast, detailed eligibility status and medical benefit information, without the hassle of juggling multiple login IDs and passwords. Eligibility Verification Medicare (formerly ABILITY CHOICE Medicare Eligibility) software enables you to submit inquiries 24/7 and receive real-time responses.

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Faster reimbursement and cash flow

Determine eligibility at the onset of a patient stay to avoid any downstream billing surprises.

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Fewer rejected claims and returns

Get the information you need about Medicare replacement plans, secondary payers, and Medicare as a secondary payer – all up front and in an instant.

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24/7 access to Medicare benefits

Gain visibility up to four months in the past and up to four months ahead through the HETS system.


Streamline Medicare eligibility verification and get the information you need in real-time, in one SaaS-based solution – no more waiting on hold or searching through complicated systems.

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Save time

Reduce administrative burden on front-office staff and simplify billing processes for backend claims submission.

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Increase revenue

Use higher performing eligibility processes to drive more paid claims at a faster rate.

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Make better-informed decisions

Gain visibility to Medicare replacement plans and secondary payers to better inform various eligibility and billing needs.

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Improve staff satisfaction

Simplify Medicare eligibility for your entire team and empower them with the tools they need to succeed.

How it Works

Confirm key Medicare benefit details with one quick, comprehensive search in one application – even with limited patient data.

Access detailed Medicare eligibility information in real-time.

Eligibility Verification Medicare gives providers 24/7 access to the Medicare benefits information they need. With multiple search criteria options, this Medicare eligibility verification software delivers instant, detailed results even if not all patient information is available for the inquiry.

The application allows staff to:

    • Use enhanced filtering to customize Service Type Code (STC) selection and save preferred options to see only the benefit responses you need to see
    • Track deductibles and benefits including therapy cap amounts, applied and remaining amounts, hospital and skilled nursing facility (SNF) co-pay days remaining, and lifetime reserve days remaining
    • See Medicare eligibility for all states and lines of business including Part A, Part B, Medicare Education Resource Center (MERC), regional home health intermediaries (RHHI), and Railroad – all in one place

Real-World Applications

Simplify and streamline Medicare eligibility verification for every inquiry, in any setting.

Skilled nursing facilities

Understand every resident’s unique benefit situation at intake, with confidence. Easily track and monitor benefits and plan for changes.

Home health organizations

Use one software solution to drive all Medicare inquiries across states and different Medicare plans.

Provider groups

Confirm every Medicare coverage detail at the start of care quickly and accurately, with just a few clicks.

Frequently Asked Questions

How fast does this deliver inquiry results?

You can expect to see eligibility information for your inquiry within seconds.

Can I see how this software works?

Yes! Please contact our team to set up a demonstration.

What if I want to check eligibility for all the payers we work with?

If you’d like to verify more than just Medicare, we recommend Eligibility Workflow for all-payer eligibility verification software.


Provider Resources

Gain insights from Inovalon case studies, infographics, videos, and other resources to get the most out of our products and solutions.

Let’s transform healthcare

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Questions? Call (301) 809-4000

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