HETS
Medicare’s HIPAA Eligibility Transaction System (HETS) underwent a release on June 13, 2020. This release will include minor changes to some information contained in Medicare eligibility responses, as outlined below. For more information, please review the HETS R2020Q200 Release Summary Document.
HETS R2020Q200 Release
June 13, 2020
| OVERVIEW | DESCRIPTION |
|---|---|
| Home Health Patient Status Code | Medicare will return the home health patient status code and its accompanying description, when applicable, for all Medicare beneficiaries. |
| Separate Hospital and Skilled Nursing Facility (SNF) Stays and Associated Billing NPIs | Medicare will specify the dates of individual hospital and SNF stays, within each Part A spell, along with the associated billing NPI for each stay.Additionally, swing bed information will be included under SNF stays. |
| Support Human Papillomavirus (HPV) Preventative HCPCS Code | Medicare will provide benefit and eligibility information for the Human Papillomavirus preventative service (HCPCS code G0476) for female Medicare beneficiaries. The response will include a CWF-calculated next eligible date based on the beneficiary’s Part B entitlement status, claim history and utilization rules. |
Medicare’s HIPAA Eligibility Transaction System (HETS) will undergo a release on November 2, 2019. This release will include minor changes to some information contained in Medicare eligibility responses, as outlined below. For more information, please review the HETS R2019Q300 Release Summary Document.
HETS R2019Q300 Release
November 2, 2019
| OVERVIEW | DESCRIPTION |
|---|---|
| MDPP Coverage Response Changes | HETS will modify the Medicare beneficiary response information to include the Medicare Diabetes Prevention Program (MDPP) end date of Period 2. HETS will continue to report a Medicare beneficiary’s financial liability for MDPP services, as well as MDPP services rendered, but the MDPP eligibility determination will use the end date of Period 2 to ensure that the system does not return active MDPP eligibility after the maximum service period has elapsed. |
| Hospice Coverage Response Changes | Effective with this release, HETS will no longer return a Hospice Occurrence Count. Instead, HETS will return all Hospice episodes and/or Notices of Election (NOE) on file for a Medicare beneficiary, regardless of the requested Dates of Service. |
UPDATED 09.09.2019
