HIPPA Eligibility Transaction System (HETS) Transition


Effective July 1, 2019, when selecting ELGA, ELGH, HIQA or HIQH, a message will display before beneficiary eligibility information is made available. This message will notify you that beginning in the fall of 2019, the Centers for Medicare & Medicaid Services (CMS) plans to terminate access to ELGA, ELGH, HIQA and HIQH for those who already use the HIPAA Eligibility Transaction System (HETS). This will affect clearinghouses, third-party billers, providers and other users. You will need to press the "ENTER" key to acknowledge the message before eligibility information displays. If you use automation methods to obtain beneficiary eligibility information via ELGA, ELGH, HIQA and HIQH, you may need to modify your program in order to accept the message. Please review DDE Guide Section 2 more details of this change.
 
If you currently use both the CWF eligibility transactions and HETS to obtain Medicare beneficiary eligibility information, it is recommended that you begin using HETS exclusively. For additional information about HETS, refer to the HIPPA Eligibility Transaction System (HETS) web page on the CMS website. Please contact your clearinghouse/vendor to notify them of this change, and ask if they offer the HETS application.

For further information, you may refer to the CMS website (PDF, 327.71 KB).





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Last Updated: 07/17/2019