Medicare HETS 270/271 Submitters:
CMS updated the HIPAA Eligibility Transaction System (HETS) Rules of Behavior. 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.”
We updated the rules to clearly state 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. You can’t use HETS to verify eligibility or coverage for Medicare Advantage (Part C) or Medicare drug (Part D) plans. For Part C, submit your eligibility inquiry to the Plan. For Part D, use E1.
If you violate these rules of behavior or we find that you’re not using it as intended, we may suspend you, place you on a corrective action plan, or refer you for investigation. You could be subject to penalties, including civil or criminal actions.
Contact the MCARE Help Desk if you have questions.