Corporate Compliance

Q&A: What is HETS?

Compliance Monitor, February 18, 2009

Q: What is HETS? How do I connect to this system?

A: The Healthcare Eligibility Transaction System (HETS) system is intended to allow release of eligibility data to Medicare providers or their authorized billing agents. Such information may not be disclosed to anyone other than the provider, supplier, or beneficiary for whom a claim is filed

The system provides access to Medicare beneficiary eligibility data in a real-time environment. The submitter transmits a 270 eligibility request file (either directly or through a switch, i.e. a clearinghouse) and remains connected while Medicare processes the transaction. Medicare then returns a response (typically, a 271 eligibility response) file via the same network connection.

HETS 270/271 is an extranet-based eligibility system for high volume providers who frequently check Medicare eligibility. The system allows providers or clearinghouses to submit HIPAA compliant eligibility request files over a secure connection. All extranet submitters must obtain a secure connection to the Medicare Data Communication Network (MDCN). Extranet submitters must also develop or acquire a mechanism to construct and send 270 eligibility request files and receive and deconstruct 271 eligibility response files in a real-time environment. The system supports real-time transactions only; the system does not accept batch transactions.

CMS is currently pilot testing HETS UI for providers who check Medicare eligibility infrequently. The HETS UI is a simple, low-cost option for Medicare providers. The only technical requirement is a secure computer with internet access. After completing registration and validation, each user is given a User ID and password. The user simply types Medicare beneficiary information into a secure, direct data entry website and clicks “submit.” If the beneficiary information is entered properly, Medicare eligibility data displays on the computer screen and can be printed as necessary. The HETS UI does not accept FTP files or batch requests; screen scraping is not permitted.

This question and answer appear on the Frequently Asked Questions section of the CMS Web site.

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