CMS Seeks Public Input on Potential Modifications to the Medicare HETS 271 Eligibility Preventive Care Business Rules for Medicare Advantage Beneficiaries

CMS is requesting feedback from the HETS 270/271 Submitter community regarding a proposed change to the HETS 271 preventive care response. 

HETS currently returns preventive services eligibility information on the 271 response when supported Healthcare Common Procedure Coding System (HCPCS) codes are submitted on the 270 request for a Medicare Beneficiary that has active Part B entitlement and does not have a Date of Death of file at the time of the request.  Preventive care information returned in the 271 response displays current date information only and no inference about historic eligibility can be made based on the returned next eligible dates.   

HETS also returns Medicare Advantage (MA) plan information on the 271 response when the Medicare Beneficiary has MA coverage that overlaps with the requested Date(s) of Service.  Whenever a Medicare Beneficiary has MA coverage, CMS strongly recommends that Medicare Providers/Suppliers contact the Medicare Advantage plan directly to confirm the Beneficiary’s MA plan eligibility information. Indication of MA coverage in a HETS 271 response does not imply or guarantee payment by the MA plan.

CMS is considering a change to the HETS 271 preventive care response for active MA Beneficiaries.  The HETS 271 response would be modified to not return any preventive services eligibility information for these Beneficiaries that have active MA coverage.  Medicare Providers/Suppliers would need to contact the Beneficiary’s MA plan for complete eligibility information, including any/all preventive services.

Submit comments in writing to the MCARE Help Desk by July 15, 2019.

Medicare Customer Assistance Re: Eligibility (MCARE) Help Desk

mcare@cms.hhs.gov