What the HETS transition means to you

Ready or not, a change is coming to your Medicare eligibility check process.

The Centers for Medicare & Medicaid Services (CMS) has officially announced the deadline for hospital, home healthcare, hospice and skilled nursing (Part A) eligibility inquiries to transition to a new platform.

On February 1, you must bid farewell to the Common Working File (CWF) and embrace the HIPAA Eligibility Transaction System (HETS) for eligibility verification.

The future for CWF and HETS

Though all eligibility inquiries will transition to HETS, CWF will still exist for claims management functions (entry/status/summary) and other transactions.

For eligibility purposes, the main difference users will notice is that HETS requires slightly different input information and returns more targeted results than CWF. Other differences include once-daily information updates and a limit of 30 eligibility requests per day.

Next steps in the HETS transition

The most important thing to do prior to the deadline is prepare. If you’re already using HETS, there’s nothing you need to do. If you’re currently using both systems, you should start using HETS exclusively.

Inovalon customers who currently use an application for eligibility verification can expect a seamless transition with no disruption to business as usual. All of our applications with integrated eligibility components are currently HETS-ready/connected. What that means for you is that February 1 will bring no changes or surprises.

To learn more about how Inovalon can provide a stress-free switch, request a demo today.

For additional information about the transition to HETS, visit the CMS announcement page.