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.

CMS offers an X12N 270/271 Eligibility System (HETS 270/271) for high volume Providers who frequently check Medicare eligibility.  This system may be accessed using the CMS Extranet or by establishing internet connectivity using Simple Object Access Protocol (SOAP) + Web Services Description Language (WSDL) envelope standards hereafter referred to simply as SOAP or Hypertext Transfer Protocol (HTTP)/Multipurpose Internet Mail Extensions (MIME) Multi-part envelope standards hereafter referred to simply as MIME.

The 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 the HETS 270/271 application - Extranet or Internet 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 application allows Providers or Clearinghouses to submit HIPAA compliant 270 eligibility request files over a secure connection. 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 application supports real-time transactions only.  The HETS 270/271 application does not accept batch transactions.

Submitters interested in the HETS 270/271 application may obtain a TCP/IP connection to the CMS Extranet or register to connect using SOAP or MIME. A TCP/IP connection can be obtained from one of the authorized Network Service Vendors. More information on how to connect via the CMS Extranet (including contact information for Network Service Vendors) or SOAP or MIME is available on the "How to Get Connected  – HETS 270/271" page.

NOTE: Insurers inquiring about how to submit 270 transactions to Medicare for Medicare Secondary Payer (MSP) Mandatory Reporting purposes should refer to the Mandatory Insurer Reporting website link found under the "Related Links Inside CMS" section below.

FAQs

Additional information regarding the HETS applications can be found on the CMS FAQ website. A link to this site is provided in the "Related Links Inside CMS" section below.