Providers using third-party vendors to check Medicare beneficiary eligibility must now enroll these vendors with CMS for HIPAA Eligibility Transaction System (HETS) access by linking each vendor to your NPI.
This includes eligibility verification performed through your clearinghouse, EHR, billing companies, and other entities that verify Medicare eligibility on your behalf. If you do not use a third party to verify patient eligibility or you verify patient eligibility through NGSConnex, this does not apply to you.
Steps to take
If you haven’t already enrolled, visit HETS EDI: How to Enroll, and follow these steps:
- Contact your vendor promptly
- Obtain their unique ID
- Use the ID to enroll and link the vendor to your NPI so they can continue submitting eligibility inquiries
Complete your enrollment by May 11 to ensure uninterrupted service. If your Medicare eligibility transactions fail with AAA error code "41" (no current, valid, relationship between the NPI and the third-party vendors), it may be due to incomplete enrollment. To prevent disruption to your services, finalize all enrollment requirements before May 11.
If you opt not to enroll, you may still check eligibility through your Medicare Administrative Contractor’s secure internet portal. After enrollment, you’ll receive monthly transaction volume reports for each vendor you enrolled.
Questions?
- For report questions, contact your vendor
- If you have concerns about your NPI being misused to check eligibility, contact mcare@cms.hhs.gov
Need additional assistance? Members can access the Members-Only Medicare page for comprehensive FAQs and additional support resources.