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WHAT IS THE HETS 270/271 SYSTEM? The Medicare 270/271 Eligibility system is intended to allow 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 system provides access to Medicare beneficiary eligibility data in a real-time environment. In this 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. There are two ways to inquire for eligibility. CMS offers an extranet-based 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 270/271 User Interface (UI) system (HETS UI) for providers who check Medicare eligibility infrequently. (See below for more info.) 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 "Connectivity Help" page. WHAT IS THE HETS USER INTERFACE (UI) SYSTEM? The HETS UI system provides users with a direct front-end interface through which to submit 270 Beneficiary Entitlement Information Requests. The user is able to submit transactions by supplying beneficiary identifiable information and receiving 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 transaction. Check back for updates as to when this transaction will be available. HOW DO WE GET ACCESS? Access Process for Clearinghouses/Providers: In order to obtain access to the HETS 270/271 via the Medicare Data Communication Network (MDCN) a submitter needs to complete the appropriate forms. You can access these forms at the bottom of this page in the Related Links Inside CMS section. The first form to be completed is the TRADING PARTNER AGREEMENT FOR SUBMISSION OF 270s TO MEDICARE ON A REAL-TIME BASIS. This agreement outlines security and privacy procedures for the submitters requesting access to the Medicare beneficiary database. In addition, all submitters must agree to CMS' Eligibility Rules of Behavior before submitting eligibility requests. If submitters do not comply with the CMS Eligibility Rules of Behavior, this could result in revoked or denied access and other penalties. The submitter must electronically provide the information requested on the form and click on the appropriate assurances. If the submitter does not consent to the terms of the agreement by appropriately completing the form, the access process will be terminated. If the submitter checks the appropriate boxes on the agreement and supplies the information requested, a copy of the completed electronic form will be submitted to the Medicare Eligibility Integration Contractor (MEIC) for security authentication. The process will then continue, and the submitter will be directed to complete the Medicare Data Communication Network (MDCN) connectivity form and submit it electronically in order to be connected to the HETS 270/271 eligibility database. Establish Submitter ID CMS staff will ensure that all of the necessary information is provided on the form, as well as ensuring that connectivity to the 270/271 application has been established. The MEIC will be responsible for contacting the Trading Partner to authenticate the identity of the accessing entity. Once authentication has been completed, the MEIC will provide the Trading Partner with a submitter ID that is required on all 270/271 transactions. Testing will be coordinated by the MEIC, and after successful testing, 270 production inquiries may be sent real-time. Please note that in order to access the Medicare Data Communication Network (MDCN), an entity must, on its own, obtain the necessary telecommunication software from the AT&T reseller. The current AT&T Resellers contact numbers are listed below: AAMVA: (813) 996-0180 IVANS: (800) 548-2675 McKesson: (800) 782-7426, option 5, and then key option 8
Page Last Modified: 02/20/2008 8:49:32 AM
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