Eligibility & Benefits
Eligibility & Benefits

Check Medicaid Eligibility, Submit Prior Auths and Track Claims on State Portals

Run the three portal tasks a Medicaid biller repeats all day, on the state’s own provider portal: verify a member and read which plan owns the claim, submit the treatment authorization request with its clinical packet, and pull claim status with the state’s denial codes. Built for Medi-Cal and Illinois HFS MEDI first, one state at a time.

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How Asteroid runs this workflow

From a member and a date of service to a routed, authorized, tracked claim

A member ID and date of service arrive, Asteroid signs in to the state portal under your enrolled-provider credentials, reads eligibility and plan assignment, submits the authorization request when one is needed, and later returns claim status with denial codes, and any coverage or coding gap stops the run for a person instead of a guess.

Medi-Cal Provider PortalMedi-Cal RxIllinois HFS MEDI

How it actually runs

  1. 01Sign in to the state portal under the enrolled provider’s credentials, handling the portal’s PIN or identity step.
  2. 02Verify eligibility by member ID and date of service. Capture aid code, coverage dates, share of cost, other health coverage, and the managed-care or county plan assignment.
  3. 03Submit the treatment authorization request with procedure and diagnosis codes, justification, and clinical attachments. Capture the TAR control number and adjudication status. On Medi-Cal Rx, submit the pharmacy PA with drug, diagnosis, and justification and capture the PA reference and determination.
  4. 04Look up claim status by claim control number or member and date of service. Capture paid or denied status, paid amount, and the state’s RAD or denial reason codes.
  5. 05Return everything as structured JSON per run, with the portal’s exact wording on any exception.

Each task is its own agent on the same portal, so eligibility, authorization, and claim status share one login and one navigation model. Build the first and the other two are cheap. Every state is a separate build, because every state portal is different.

A member identifier (CIN, recipient ID, or SSN) and a date of service are ready

  6. Eligibility, authorization, and claim status in your billing queue

    Each member’s eligibility response, plan assignment, TAR control number and adjudication status, and claim status with denial codes land in your billing system, traceable to the portal screen they came from.

Member not found, coverage gap, or missing coding: A member the portal cannot find, a date of service outside coverage, or a TAR missing a required code or attachment stops the run with the portal’s wording attached. A person resolves it once. Nothing is submitted on a guess.

State portal access is the hard part

Medi-Cal requires an enrolled provider number as the user ID, a DHCS-issued PIN, and a signed Point of Service network agreement on file. Illinois requires a State of Illinois digital identity and per-provider registration against each Medicaid provider ID, with a billing-agent path for vendors. No vendor can self-register on either. The credential comes from the enrolled provider, and an organization administrator on the provider side provisions it. That is a week of paperwork before the first run, and it is the reason most billing vendors still have people logging in by hand. Plan for it up front.

At scale

What runs today

These state-portal agents are in the catalogue pipeline, built state by state as customers bring an enrolled-provider credential. The same three-task shape runs today on commercial payers: eligibility and benefits checks, prior authorization with attachments and clinical questions, and claim status with denial retrieval. A Medicaid TAR is the same submission shape on a different portal. If your state is decided and your credential exists, scope the build against that portal; the rest of the category is in the eligibility library.

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Questions

Frequently asked questions

Medi-Cal (the Medi-Cal Provider Portal and the separate Medi-Cal Rx pharmacy portal) and Illinois HFS MEDI are the first two. Each state is its own agent build against the same three tasks: eligibility, authorization request, claim status. A new state needs an enrolled-provider credential from you and a scoping session against that portal. The login and navigation work is shared across the three tasks on one portal, so the second and third tasks on a state cost far less than the first.

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Disclaimer

Third-party names, including government agencies and registries, are used only to identify systems commonly involved in healthcare operations workflows. Asteroid is not affiliated with, endorsed by, sponsored by, or certified by those third parties unless expressly stated. Workflow availability depends on customer authorization, account permissions, configuration, and applicable system terms.