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HIPAA Eligibility Transaction System (HETS) Help (270/271)


The HIPAA Eligibility Transaction System (HETS) is intended to allow the release of eligibility data to Medicare Providers, Suppliers, or their authorized billing agents for the purpose of preparing an accurate Medicare claim, determining Beneficiary liability or determining eligibility for specific services. Such information may not be disclosed to anyone other than the Provider, Supplier, or Beneficiary for whom a claim is filed.

There are two ways to inquire for eligibility. CMS offers an Extranet-based X12N 270/271 Eligibility System (HETS 270/271) for high volume Providers who frequently check Medicare eligibility. CMS also is currently pilot testing an internet-based User Interface (UI) System (HETS UI) for Providers who check Medicare eligibility infrequently.

The HIPAA Eligibility Transaction System (HETS) Help site is designed, in conjunction with the MCARE Help Desk, to provide technical System support to CMS business partners for the initiation, implementation, and operation of Medicare HETS User Interface (UI) and HETS 270/271 - Extranet Transaction Submission. This information is provided to assist external business partners with connectivity, testing, and data exchange with CMS and to keep users informed of any system issues that may arise.

HETS 270/271

The HETS 270/271 allows Providers or Clearinghouses to submit HIPAA compliant 270 eligibility request files over a secure connection. All HETS 270/271 submitters must obtain a secure connection to the Medicare Data Communication Network (MDCN). HETS 270/271 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 HETS 270/271 System supports real-time transactions only; the System does not accept batch transactions.

If you are interested in the HETS 270/271 System, your organization must obtain an AT&T Global Network Service (AGNS) connection to the MDCN network. An AGNS connection can be obtained from one of the authorized AT&T Resellers: AAMVA, IVANS or McKesson. More information on how to connect (including contact information for AAMVA, IVANS and McKesson) is available on the "How to Get Connected – HETS 270/271" page.


The HETS UI System provides users with a direct front-end interface to submit Beneficiary Entitlement information requests. The user is able to submit transactions by entering Beneficiary information and receive a real-time response online. Thus, the user does not need to be concerned with X12 formatting, any transaction set formulation, or an AT&T Global Network Service (AGNS) connection to the Medicare Data Communication Network (MDCN) network.

CMS is currently pilot-testing this system. Check back for updates as to when this system will be more widely available.



HETS 270/271 User Companion Guide[PDF,516KB]

HETS UI User Companion Guide[PDF,1.67MB]

Related Links Inside CMS

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Related Links Outside CMSExternal Linking Policy

Current System Status: www.hetsstatus.com


Page Last Modified: 09/08/2008 2:22:32 PM
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