New HETS Replaces Medicare CWF Queries

The Centers for Medicare and Medicaid Services (CMS) has issued Medlearn Matters Article SE1249 advising providers and suppliers of the new Health Insurance Portability and Accountability Act (HIPAA) Eligibility Transaction System (HETS).  The HETS is designed to replace the current Common Working File (CWF) query system.  According to CMS, if you currently use CWF queries to obtain Medicare health insurance eligibility information for Medicare fee-for-service patients, you should immediately begin transitioning to the HETS.

In 2005, CMS began offering HETS in a real-time environment.  HETS is a fully HIPAA compliant eligibility benefit inquiry and response electronic transaction (ASCX12 270/271 Version 5010) system.  HETS replaces the CWF queries, and is to be used for the business of Medicare; such as preparing an accurate Medicare claim or determining eligibility for specific services.

CMS plans to discontinue access to the CWF queries through the shared systems. Therefore, Medicare providers and their agents that currently access the CWF queries through the shared system screens will need to modify their business processes to use HETS to access Medicare beneficiary eligibility information.

The Medlearn Matters article linked above contains more details on HETS including a link to the CMS help line and some frequently asked questions.

Contact: Patrick Cucinelli, pcucinelli@leadingageny.org, 518-867-8827