BENEFICIARY ELIGIBILITY LOOKUP * All fields are mandatory

Name

Gender

Medicare Part B Coverage

Remaining Share of Cost

Date of Birth

Beneficiary ID Number

Medicare Part D Coverage

Status

Service Date

Other Health Coverage

Effective Date	Termination Date

Two or more active eligibility dates represents beneficiary's eligibility across different categories

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Service Date ↓ ↑	Rx Number ↓ ↑	Drug Name ↓ ↑	Prescriber Name ↓ ↑	Pharmacy ↓ ↑	Amount Paid ↓ ↑	Claim Status ↓ ↑	Action