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Determining Medicaid Eligibility via SunFire and Carrier Portals

How to check Medicare & Medicaid eligibility through SunFire and carrier portals.

How to look up Medicaid eligibility via SunFire

Sunfire will be supporting Medicaid eligibility look-ups in 48 states by AEP 2027. Medicaid look up in Alaska and Hawaii will not be supported.

DSNP Enrollment & MCO Validation

Sunfire now offers a new secondary medicaid validation that will check if a beneficiary is eligible for the specific D-SNP plan (when carrier data is available). This validation will occur automatically when an agent clicks "Enroll." Agents will see messaging when a potential carrier eligibility misalignment is detected to help reduce submission risk.

Additionally Sunfire supports MCO alignment validation to help identify and prevent enrollments that don't align with a beneficiary's Managed Care Organization (MCO). Agents will see a warning when the beneficiary's MCO does not align with the selected plan, alerting agents to review the information before proceeding.

Sunfire will not block an enrollment from happening if there is MCO misalignment on the application.

Click the link below for a walkthrough:

How to look up Medicaid & Medicare Eligibility in Spark Quote and Enroll

How to look up Medicaid Eligibility via Carrier Portals

Anthem (mProducer)

  1. Log into mProducer

  2. Click Eligibility Check \ Medicare and Medicaid

  3. Click DSNP Eligibility Check and enter all applicable information

  4. Enter all required fields and click Check Eligibility

Cigna (HealthSpring)(Cigna for Brokers)

  1. Log into Cigna for Brokers

  2. Click Continue for the pop-up box

  3. Click Tools on the left-hand navigation menu

  4. Click Medicare/Medicaid Eligibility

  5. Enter the required information and click Medicare Status

Humana (Vantage)

  1. Log into Human Vantage

  2. Click Eligibility Verification in the Quote & Enroll section

  3. Click DSNP Eligibility and complete all required fields, then click Submit

UHC (Jarvis)

  1. Log into Jarvis

  2. Click Sales Tools on the top dark blue banner

  3. Click Medicare & Medicaid Eligibility Lookup

  4. Click Medicaid Eligibility and complete all required fields, and click Check Medicaid Eligibility

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