Medicare HETS 270/271 Submitters:
CMS would like to remind all HETS Submitters and your clients to review the HIPAA Eligibility Transaction System (HETS) Rules of Behavior. Please review the rules and share them with the parties that use your services to connect to HETS listed under “Who Needs to Follow These Rules.”
As a reminder, the rules clearly state that HETS is for enrolled Medicare Fee-for-Service (FFS) health care providers and suppliers with a FFS electronic data interchange enrollment to submit Medicare claims to a Medicare Administrative Contractor. Submitters may not use HETS to verify eligibility or coverage for Medicare Advantage (Part C) or Medicare drug (Part D) plans. For Part C, please submit your eligibility inquiry to the Plan and for Part D, please use E1.
Any violations of the HETS Rules of Behavior may result in the possible suspension of your organization’s Submitter ID, placement of your organization on a corrective action plan, or a referral of your organization for investigation. Your organization could be subject to penalties, including civil or criminal actions.
Please contact the MCARE Help Desk if you have questions.