HIPAA Eligibility Transaction System (HETS) Help (270/271)
The HIPAA Eligibility Transaction System (HETS) is intended to allow the release of eligibility data to Medicare Providers, Suppliers, or their authorized billing agents for the purpose of preparing an accurate Medicare claim, determining Beneficiary liability or determining eligibility for specific services. Such information may not be disclosed to anyone other than the Provider, Supplier, or Beneficiary for whom a claim is filed.
There are two ways to inquire for eligibility. CMS offers an Extranet-based X12N 270/271 Eligibility System (HETS 270/271) for high volume Providers who frequently check Medicare eligibility. CMS also is currently pilot testing an internet-based User Interface (UI) System (HETS UI) for Providers who check Medicare eligibility infrequently.
The HETS Help site is designed, in conjunction with the MCARE Help Desk, to provide technical System support to CMS business partners for the initiation, implementation, and operation of the Medicare HETS UI Internet application and the HETS 270/271 application - Extranet Transaction Submission. This information is provided to assist external business partners with connectivity, testing, and data exchange with CMS and to keep users informed of any system issues that may arise.
The HETS 270/271 application allows Providers or Clearinghouses to submit HIPAA compliant 270 eligibility request files over a secure connection. All HETS 270/271 submitters must obtain a secure connection to the CMS Extranet. HETS 270/271 submitters must also develop or acquire a mechanism to construct and send 270 eligibility request files and receive and deconstruct 271 eligibility response files in a real-time environment. The HETS 270/271 application supports real-time transactions only; the application does not accept batch transactions.
If you are interested in the HETS 270/271 application, your organization must obtain an IP connection to the CMS Extranet. An IP connection can be obtained from one of the authorized Network Service Vendors. More information on how to connect (including contact information for Network Service Vendors) is available on the "How to Get Connected – HETS 270/271" page.
NOTE: If you are an insurer inquiring about how to submit 270 transactions to Medicare for Medicare Secondary Payer (MSP) Mandatory Reporting purposes, please refer to the Mandatory Insurer Reporting website link found under the "Related Links Inside CMS" section below.
The HETS UI Internet application provides users with a direct front-end interface to submit Beneficiary eligibility information requests. The user is able to submit transactions by entering Beneficiary information and receive a real-time response online. Thus, the user does not need to be concerned with X12 formatting, any transaction set formulation, or an IP connection to the CMS Extranet.
CMS is currently pilot-testing this system. Check back for updates as to when this system will be more widely available.
Additional information regarding the HETS applications can be found on the CMS FAQ website. A link to this site is provided in the "Related Links Inside CMS" section below.
- Page last Modified: 07/03/2012 2:04 PM
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