How to Get Connected - HETS 270/271

HOW TO GET ACCESS

Access Process for Clearinghouses/Providers:

In order to obtain access to the HETS 270/271 application via the CMS Extranet, a submitter needs to complete a Trading Partner Agreement. You can access this form from the Downloads section at the bottom of this page.

The HETS 270/271 Trading Partner Agreement outlines security and privacy procedures for the submitters requesting access to the Medicare Beneficiary database. In addition, all submitters must agree to CMS Eligibility Rules of Behavior before submitting eligibility requests. If submitters do not comply with the CMS Eligibility Rules of Behavior, this could result in revoked or denied access and other penalties.

The submitter must electronically provide the information requested on the form and click on the appropriate assurances. If the submitter does not consent to the terms of the agreement by appropriately completing the form, the access process will be terminated.

If the submitter checks the appropriate boxes on the agreement and supplies the information requested, a copy of the completed electronic form will be submitted to the Medicare Customer Assistance Regarding Eligibility (MCARE) Help Desk for security authentication and connection to the HETS 270/271 application's eligibility database.

Establish Submitter ID

CMS staff will ensure that all of the necessary information is provided on the form, as well as ensuring that connectivity to the HETS 270/271 application has been established. The MCARE HELP DESK will be responsible for contacting the Trading Partner to authenticate the identity of the accessing entity. Once authentication has been completed, the MCARE HELP DESK will provide the Trading Partner with a submitter ID that is required on all HETS 270/271 application transactions. Testing will be coordinated by the MCARE Help Desk, and after successful testing, 270 production inquiries may be sent real-time. 

The current Network Service Vendors' contact numbers and email addresses are listed below:

• IVANS:  (800) 548-2675, Health.Services@ivans.com
• McKesson:  (888) 663-6250, quote@carebridge.net
• ABILITY:  (888) 895-2649, sales@abilitynetwork.com
• AHDS:  (877) 214-0990, info@ahds.com

CONNECTION OVERVIEW

Trading Partners will access the CMS Data Center, via the CMS Extranet, to send their eligibility requests. This Extranet is a secure, closed, private network currently used to transmit data between CMS and CMS Business Partners.

For a 270 real-time inquiry, the software at the CMS data center will translate the incoming 270, perform validations, request Beneficiary eligibility information from the CMS eligibility database, and create either a 271, 999, TA1 or proprietary response.  The HETS 270/271 application will automatically terminate a session (without notice) if the socket has been idle for more than 5 seconds.  If this occurs, open a new socket and resume sending transactions.  For additional information regarding connectivity best practices, please refer to the Best Practices document found in the Downloads section below.

CMS will continue to hold Clearinghouses responsible for the privacy and security of eligibility transactions sent directly to them from Providers, and will require them to be able to associate each inquiry with a Provider. Provider authentication must be established outside of the transaction. Trading Partners must not send User IDs and passwords within the 270 eligibility transaction.

HOW TO OBTAIN A CONNECTION TO THIS SERVICE

To sign up as a HETS 270/271 submitter, your organization must complete a Trading Partner Agreement and obtain a connection to the CMS Extranet via an IP connection.

You can obtain an IP connection from one of the approved Network Service Vendors. Contact information for each company is available within the "Establish Submitter ID" section above.  Please contact the Network Service Vendors for pricing and additional information.

Once you have reached the CMS Extranet via an IP connection, you can then access the Medicare HETS 270/271 application to inquire for eligibility.

BEST PRACTICES

CMS has compiled a list of HETS submitter DOs and DONTs to provide additional guidance regarding HETS 270/271 communications best practices.  A copy of the Best Practices document is available in the Downloads sections below.

CMS requires that all HETS 270/271 submitters read this document and then review their HETS communication protocol practices to ensure that their organization is following these best practices.  CMS will contact submitters whose behavior is not consistent with these practices to determine the submitter's action plan to improve.