HIPAA Eligibility Transaction System (HETS)

The HIPAA (Health Insurance Portability and Accountability Act) Eligibility Transaction System (HETS) allows you to check Medicare beneficiary eligibility data in real-time. Use HETS to prepare accurate Medicare claims, determine beneficiary liability, or check eligibility for specific services.

HETS allows users to submit HIPAA compliant 270 eligibility request files over a secure connection and receive 271 response files. Submitters must develop or acquire a tool to construct and send 270 eligibility request files and receive and deconstruct 271 eligibility response files in a real-time environment. HETS 270/271 application supports real-time transactions only.  The HETS 270/271 application does not accept batch transactions.

Our Current HDT User Guide (PDF) will help you get started. 

Recent Announcements

• Medicare HETS - Upcoming HETS2024-4 System Release - 11/4/2024
• Medicare HETS 270/271 - Information Bulletin - HETS Rules of Behavior

Important Announcements:

• Medicare HETS 270/271 - Information Bulletin - HETS Rules of Behavior
• Medicare HETS - Information Bulletin - Citrix Bleed Vulnerability: Act Now
• Medicare HETS 270/271 - Information Bulletin - MSP Diagnosis Codes - September 6, 2023

System Maintenance

The HETS 270/271 application is typically available 24 hours a day, 7 days a week.  At this time, there are no standing HETS 270/271 maintenance windows.  MCARE will notify HETS Trading Partners of any planned downtime.  All current and archived downtime notifications are available via the MCARE Notifications link.

Contact Us

The MCARE Help Desk is accessible Monday through Friday, from 7 am to 7 pm ET. The MCARE Help Desk complete contact information, hours of operation, holiday schedule, and more is available here. Be ready to provide examples of any issues in a timely manner for proper support.

• mcare@cms.hhs.gov
• 1-866-324-7315