Tag: HIPAA Eligibility Transaction System

Attention Billers: Medicare Secondary Payer Problem With HETS

The Centers for Medicare & Medicaid Services (CMS) and the Medicare Administrative Contractors (MACs) are aware of a problem with the HIPAA Eligibility Transaction System (HETS) Medicare Secondary Payer (MSP) data received from the Common Working File (CWF).  The MACs’ eligibility systems/portals that receive MSP data from HETS may be affected by this issue. Due…

CMS to Shutter Common Working File for Eligibility Queries Effective February 1, 2020

The Centers for Medicare & Medicaid Services (CMS) has been working over recent years to migrate queries related to benefit eligibility from the Common Working File (CWF) and to establish the HIPAA Eligibility Transaction System (HETS) as the single source for beneficiary eligibility transactions.  The National Association for Home Care & Hospice (NAHC) has been…

Movement to HETS as Sole Source for Eligibility Queries on Horizon

CWF: 3rd and later hospice benefit periods not calculating correctly In recent years, the Centers for Medicare & Medicaid Services (CMS) has taken steps to transition providers away from direct queries to the Common Working File (CWF) and toward the HIPAA Eligibility Transaction System (HETS) as the single source for beneficiary eligibility transactions.  Earlier this…

CMS Announces Further Changes to Support Hospice Eligibility Inquiries in HETS

Over recent years the Centers for Medicare & Medicaid Services (CMS) has sought to streamline hospice beneficiary eligibility inquiries and establish the HIPAA Eligibility Transaction System (HETS) as the single source for this data. This effort was delayed due in part to the availability of insufficient information in the HETS system regarding hospice benefit period…