The HIPAA Eligibility Transaction System (HETS) is intended to allow the release of eligibility data to Medicare providers 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. The information included in the 271 response is not intended to provide a complete representation of all benefits, but rather to address the status of eligibility (active or inactive) and patient financial responsibility for Medicare Part A and Part B.The data included in a 271 response file is to be considered true and accurate only at the particular time of the transaction. The HETS 270/271 application provides access to Medicare Beneficiary eligibility data in a real-time environment. In real-time mode, the Trading Partner transmits a 270 request and remains connected while the receiver processes the transaction and returns a 271 response. Providers, Clearinghouses, and/or Third Party Vendors, herein referred to as “Trading Partners”, may initiate a real-time 270 eligibility request to query coverage information from Medicare on patients for whom services are scheduled or have already been delivered.
Please refer to the HETS 'How To Get Connected' page on the cms.gov website for additional information on how to obtain a connection to, and then apply for, HETS access. Please contact the Help Desk if you have any questions. Call: 1-866-324-7315
. You can also email the help desk at mcare@cms.hhs.gov. This email address is monitored Monday - Friday 7AM - 7PM ET. Emails are typically answered within 24-48 business hours.
(FAQ2151)
