05/16/2011

Medicare HETS UI Internet Eligibility Submitters:

On April 25, 2011 CMS advised that its regular daily updates to HETS Medicare eligibility data would be temporarily suspended beginning on Saturday, April 30, 2011. This temporary change was due to an enterprise level database architecture change.

CMS completed these database architecture changes and resumed daily updates to HETS Medicare eligibility data on Sunday, May 8, 2011. CMS has, however, identified an issue with the Medicare Advantage (MA) Managed Care (MCO) data that was returned by HETS once this change was effected.

For the period of Sunday, May 8, 2011 " Saturday, May 14, 2011 HETS Medicare eligibility responses indicated that all Medicare Advantage Managed Care enrolled beneficiaries were enrolled in a Health Maintenance Organization (HMO) Medicare Risk plan. HETS returned a 'HN' Insurance Type Code on the Plan Coverage tab to indicate that the Medicare Advantage plan was HMO Medicare Risk for all MA plans, regardless of their proper plan designation.

CMS resolved this issue on Saturday, May 14, 2011. HETS responses are now returning the proper MA plan Insurance Type Code on the Plan Coverage tab. CMS deeply regrets any inconvenience this may have caused Medicare beneficiaries or providers and suppliers. HETS submitters may wish to resubmit eligibility requests sent during the May 8-14, 2011 period to ensure proper service and billing for Medicare beneficiaries.

Please contact the MCARE Help Desk if you have any additional questions.

Medicare Customer Assistance Re: Eligibility (MCARE) Help Desk
1-866-440-3805