CMS HIPAA Eligibility Transaction System (HETS)
Investment ID: 009-000004414
Overview
Program Title
CMS HIPAA Eligibility Transaction System (HETS)
Description
This investment supports strategic standardization efforts & ensures CMS Medicare product interoperability. This portfolio includes the CMS Medicare system that processes eligibility transactions.The Health Insurance Portability and Accountability Act (HIPAA) Eligibility Transaction System (HETS) is a mission critical CMS system. HETS is an Electronic Data Interchange (EDI) application that enables Medicare providers, suppliers, and their authorized representatives to request Medicare beneficiary eligibility data and receive a response in real-time for the purposes of preparing an accurate Medicare claim, determining beneficiary liability, and/or determining beneficiary eligibility for specific services.
Type of Program
Major IT Investments
Multi-Agency Category
Not Applicable
Associated Websites
https://www.cms.gov/Research-Statistics-Data-and-Systems/CMS-Information-Technology/HETSHelp/index.html?redirect=/HETSHelp
Investment Detail
The Medicare program is a Federal health insurance program administered by CMS. Medicare provides health care coverage for US citizens and their dependents aged 65 or older, disabled, and those with End Stage Renal Disease (ESRD). As part of its role as a provider of health care coverage, CMS is required to provide beneficiary eligibility information to health care providers using Health Insurance Portability and Accountability Act (HIPAA) standards and the Council for Affordable Quality Healthcare/Committee on Operating Rules for Information Exchange (CAQH/CORE).
The HIPAA Eligibility Transaction System (HETS) is a CMS mission critical system. HETS is an Electronic Data Interchange (EDI) application that enables Medicare providers, suppliers, and their authorized representatives to request Medicare beneficiary eligibility data (270 transactions) and receive a response (271 transactions) in real-time for the purposes of preparing an accurate Medicare claim, determining beneficiary liability, and/or determining beneficiary eligibility for specific services. HETS is comprised of two applications, HETS 270/271 and HETS Desktop (HDT).
The HETS investment includes two IT contracts:
1. The Beneficiary Eligibility Suite of Systems and Transactions (BESST) contract provides software design, development, and maintenance services for the HETS 270/271 and HDT applications. Additionally, the BESST contract includes monitoring of the production systems, project management, integration services. The Medicare Customer Assistance Regarding Eligibility (MCARE) Help Desk is also a component of the BESST contract. MCARE accepts inquiries from HETS providers and their authorized representatives via a toll-free number and an email box. MCARE provides HETS user documentation and notifications via the HETS Help website.
2. The HETS Independent Testing Contract (HITC) provides independent testing and validation for the applications.
HETS is a steady state investment. Since its inception in 2005, HETS continues to exceed performance goals to best meet strategic and business requirements into the foreseeable future for customer satisfaction.
The HIPAA Eligibility Transaction System (HETS) is a CMS mission critical system. HETS is an Electronic Data Interchange (EDI) application that enables Medicare providers, suppliers, and their authorized representatives to request Medicare beneficiary eligibility data (270 transactions) and receive a response (271 transactions) in real-time for the purposes of preparing an accurate Medicare claim, determining beneficiary liability, and/or determining beneficiary eligibility for specific services. HETS is comprised of two applications, HETS 270/271 and HETS Desktop (HDT).
The HETS investment includes two IT contracts:
1. The Beneficiary Eligibility Suite of Systems and Transactions (BESST) contract provides software design, development, and maintenance services for the HETS 270/271 and HDT applications. Additionally, the BESST contract includes monitoring of the production systems, project management, integration services. The Medicare Customer Assistance Regarding Eligibility (MCARE) Help Desk is also a component of the BESST contract. MCARE accepts inquiries from HETS providers and their authorized representatives via a toll-free number and an email box. MCARE provides HETS user documentation and notifications via the HETS Help website.
2. The HETS Independent Testing Contract (HITC) provides independent testing and validation for the applications.
HETS is a steady state investment. Since its inception in 2005, HETS continues to exceed performance goals to best meet strategic and business requirements into the foreseeable future for customer satisfaction.