PayerLink - Medicare Eligibility (HETS) Medicare Eligibility Verification

Overview

HETS or HIPAA Eligibility Transaction System is a real time eligibility inquiry system developed by Centers for Medicare & Medicaid Services (CMS). HETS is updated each night by the Common Working File (CWF) so it contains billing data collected through the previous day. This system uses the HIPAA 270/271 transaction to respond to eligibility verification and benefit inquiries.

What is HETS used for?

HETS includes data for specific services such as home health and hospice as well as general Medicare eligibility information. This data can be used to make detailed reports displaying a patient's prior billing history including providers they have seen and secondary/Part D coverage.

  • Verify eligibility, after screening the patient to determine Medicare eligibility, for Part A or Part B of Medicare
  • Determine beneficiary payment responsibility with regard to deductible/co-insurance
  • Determine eligibility for services such as preventive services
  • Determine if Medicare is the primary or secondary payer
  • Determine if the beneficiary is in the original Medicare plan, Part C plan (Medicare Advantage) or Part D plan
  • Determine proper billing

Medicare Eligibility Verification in PayerLink

PayerLink allows unlimited eligibility inquiries between a Medicare provider and CMS. Each inquiry takes about 2 seconds to execute and creates a report that can be printed or saved for future reference.

  • Unlimited transactions for a low flat fee
  • Real time eligibility inquiries within seconds
  • Intuitive interface to request and compare benefit information
  • Past, present and future information included in the eligibility response
  • Report includes Part A, B, D, MSP, Medicare Advantage, Home Health and Hospice information

See what our customers are saying!

"PayerLink provides direct access to the CMS HETS system. Through this service, we can get instant and unlimited Medicare eligibility reports from any computer, any time."

- Caldwell Hospice and Palliative Care