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"The Center for Medicare & Medicaid Services (CMS) is committed to maintaining the integrity and security of health care data in accordance with applicable laws and regulations. Disclosure of Medicare beneficiary eligibility data is restricted under the provisions of the Privacy Act of 1974 and the Health Insurance Portability and Accountability Act of 1996 (HIPAA.) The provider Medicare beneficiary eligibility transaction is to be used for conducting Medicare business only. Please become familiar with the security related documents on this page and understand we monitor the transaction for aberrant behavior." Refer to Section 10.3 of the Medicare Claims Processing Manual below. Important Notice Threshold Errors The Medicare HETS Internet Eligibility System will undergo changes effective Saturday, May 19, 2007, that will impact how it currently responds. Specifically, transparent threshold changes will be made that could temporarily interrupt your access to the HETS Internet Eligibility System when your system activity deviates from that which is considered normal. The threshold changes relate to the number of eligibility requests you make to the system where the beneficiary identifying information you input does not match the beneficiary data maintained by Medicare. You will know when you reach this threshold as you will receive the following error message: "You have exceeded the error limit related to entering incorrect subscriber identifying information resulting in the termination of you session." When you receive this message, you must log into the HETS Internet Eligibility System again to establish a new session. Please ensure you properly screen each beneficiary so the beneficiary data you input to the Medicare Eligibility Benefit Inquiry screen is correct and matches the beneficiary data maintained by Medicare. The easiest way to obtain the correct spelling of the beneficiary's name and determine his/her Medicare claim number (also referred to as the Health Insurance Claim Number) is to review the Beneficiary's Medicare Health Insurance Card. The MCARE Help Desk can assist you with any questions you may have regarding any issues you may encounter. If you have any questions or concerns, please feel free to contact the Help Desk listed on the Contact Us page.
Page Last Modified: 01/03/2008 9:29:43 AM
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