Home Health & Hospice Medicare Eligibility Queries Are Changing

Transition to HETS.

CMS recently announced an April 1st date to eliminate access to CWF eligibility query functions in the following systems, also referred to as PPTN and VPIQ:

Multi-Carrier System (MCS)
ViPS Medicare System (VMS)

CMS also plans to terminate access to other CWF eligibility queries/areas, however no date has been announced on when this will occur. These areas include:

Fiscal Intermediary Standard System (FISS)
Direct Data Entry (DDE)

  • HIQA
  • HIQH
  • ELGA
  • ELGH
  • HUQA

Even after CMS terminates access to the eligibility areas of DDE, Providers will still be able to use the DDE to submit claims or to correct claims. In addition, the transition will not impact access to beneficiary eligibility information from Medicare Contractor’s Interactive Voice Response (IVR) units and/or Internet portals.

For full details on the transition to the HETS system click here.

If your agency utilizes a third party vendor for your DDE connectivity, you are encouraged to check with them to make sure that they will be ready for this transition.

HEALTHCAREfirst is happy to inform our customers who use our Medicare connectivity product, firstCONNECT, that you ALREADY have eligibility access and information based on the HIPAA Eligibility Transaction System (HETS) 270/271 claim transactions. HEALTHCAREfirst providers that use Enterprise Edition’s Eligibility checking function will be converted to HETS 270/271 claim transactions soon.

firstCONNECT from HEALTHCAREfirst offers you a real-time, high-speed Medicare connection using the latest technology.  With no additional hardware to purchase, this CMS-approved connectivity allows you to successfully automate the DDE process including batch file transfer, eligibility checks and Web-based DDE connectivity.  When used together with Business Intelligence, you will gain unsurpassed insight into your entire business operation, ensuring that you prepare an accurate claim every single time.