mMR Eligibility Checks
This job aid guides Mindoula Teams through the process for checking Member health plan eligibility via mMR. Verifying eligibility in real time provides Team members with the information needed to follow enrollment and discharge procedures, and to support Members in navigating healthcare coverage.
Process:
Care Teams are to check eligibility upon each enrollment engagement with a Pending Member and as needed with Active Members, , by navigating to the Eligibility Tab in the mMR under “View all”:
Once in the Eligibility Tab, click “Refresh Eligibility from Availity” to pull current eligibility status:
Team Members will not call Pending Members who have inactive coverage, and will follow Standard Operating Procedures to inform Active Members of eligibility status, support Medicaid renewal and/or follow program specific discharge requirements as needed.