Every Sunday from 10:00 P.M. until Monday 3:00 A.M. Eastern, there is a regularly scheduled maintenance period to include routine server rebooting. During this period, the system is unavailable and transactions will not be processed. Please plan accordingly.
If you have any questions or comments, please contact the Help Desk.
Medicare HETS 270/271 Submitters:
CMS is planning to install an off-quarter HETS 270/271 system release on Saturday, January 10, 2009. The HETS 270/271 system will be available during this time however, submitters may received sporadic AAA03= 42 responses between 7am EST to 12pm EST. This off-quarter release will enhance the 271 responses submitters receive from the HIPAA Eligibility Transaction System (HETS) 270/271. No content changes to the 270 will be required for this release. HETS 270/271 submitters should, however, review the information below for important changes in the HETS 271 response and prepare as necessary. The HETS 270/271 companion guide has been updated to reflect this change and can be referred to in the "Downloads" section below.
The OQ2008Q402 HETS 270/271 release will address an issue with the Insurance Type Code returned for Medicare Advantage HMO non-risk plans.
Insurance Type Codes
The HETS 270/271 application utilizes a variety of 271 2110C EB04 Insurance Type Codes to identify different types of Managed Care Organizations (MCOs). HETS 270/271 currently utilizes a 271 2120C NM101 value of "PRP" for all of the different MCOs. HETS 270/271 should be returning a 271 2120C NM101 value of "PR" for Medicare Advantage HMO non-risk plans. Medicare Advantage HMO non-risk plans are identified by 271 2110C EB04 Insurance Type Code "HM".
CMS will modify the HETS 270/271 application to return the correct value in the 271 2120C NM101 value for Medicare Advantage HMO non-risk ("HM") plans.
Submitters should contact all MCOs, especially the Medicare Advantage HMO non-risk plans, regarding appropriate claim filing information.
Please contact the MCARE Help Desk if you have any questions or comments.
Medicare Customer Assistance Re: Eligibility (MCARE) Help Desk
1-866-324-7315
Medicare HETS 270/271 Submitters:
Medicare HETS 270/271 Submitters:
CMS continues to conduct random audits of HETS 270/271 transactions. Components of these audits ensure that submitters are complying with the requirement to submit 270 eligibility requests only for valid, active Medicare providers and/or suppliers.
Effective January 1, 2009, CMS will strengthen the Medicare provider audit criteria for all HETS 270/271 submitters. CMS will set a 99% match requirement to allow for occasional typographic errors, lags in provider enrollment and updates to data. There, CMS institute audits requiring that no more than 1% of NPI numbers submitters be non-matched in the Medicare NPI crosswalk and that at least 99% of all transactions submitted contain a valid NPI number that appears in the Medicare NPI crosswalk.
Submitters who fail random audits will face suspension of their trading privileges.
Per the Trading Partner Agreement, all HETS 270/271 submitters must take the necessary steps to ensure that only valid, active Medicare provider NPI numbers are used to receive beneficiary eligibility information. Your cooperation in this endeavor is vital.
If you have questions about any information contained within this notification, please contact the Help Desk immediately.
Medicare Customer Assistance Re: Eligibility (MCARE) Help Desk
1-866-324-7315
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