Medicare HETS 270/271 Submitters:
CMS is planning to install an off-quarter HETS 270/271 system release on Saturday, January 10, 2009. The HETS 270/271 system will be available during this time however, submitters may received sporadic AAA03= 42 responses between 7am EST to 12pm EST. This off-quarter release will enhance the 271 responses submitters receive from the HIPAA Eligibility Transaction System (HETS) 270/271. No content changes to the 270 will be required for this release. HETS 270/271 submitters should, however, review the information below for important changes in the HETS 271 response and prepare as necessary. The HETS 270/271 companion guide has been updated to reflect this change and can be referred to in the "Downloads" section below.
The OQ2008Q402 HETS 270/271 release will address an issue with the Insurance Type Code returned for Medicare Advantage HMO non-risk plans.
Insurance Type Codes
The HETS 270/271 application utilizes a variety of 271 2110C EB04 Insurance Type Codes to identify different types of Managed Care Organizations (MCOs). HETS 270/271 currently utilizes a 271 2120C NM101 value of "PRP" for all of the different MCOs. HETS 270/271 should be returning a 271 2120C NM101 value of "PR" for Medicare Advantage HMO non-risk plans. Medicare Advantage HMO non-risk plans are identified by 271 2110C EB04 Insurance Type Code "HM".
CMS will modify the HETS 270/271 application to return the correct value in the 271 2120C NM101 value for Medicare Advantage HMO non-risk ("HM") plans.
Submitters should contact all MCOs, especially the Medicare Advantage HMO non-risk plans, regarding appropriate claim filing information.
Please contact the MCARE Help Desk if you have any questions or comments.
Medicare Customer Assistance Re: Eligibility (MCARE) Help Desk
1-866-324-7315