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Home Tricare 2019 January CMS Announces Plan to Discontinue CWF Eligibility

CMS Announces Plan to Discontinue CWF Eligibility

CMS sent out the announcement below on 12/7/2018 regarding the phasing out of the Common Working File for eligibility. It’s taken 6 years but CMS finally feels they have data parity between their X12 eligibility solution and the common working file. The phase out is scheduled to begin in Summer 2019.

In December 2012, CMS announced plans to discontinue the Common Working File (CWF) beneficiary health insurance eligibility transactions (MLN Matters® Special Edition Article SE1249).  In that same article, CMS also announced the HIPAA Eligibility Transaction System (HETS) would be the single source for this data. CMS subsequently delayed this effort based on feedback about the differences in data returned between the two systems and the one-year limit to HETS historical search capability. CMS resolved these issues and is moving forward to phase-out the CWF beneficiary health insurance eligibility transactions. This will address inefficiencies of maintaining two different systems returning the same data.

Beginning in the summer of 2019, CMS plans to terminate access to CWF eligibility queries for those who already utilize HETS. If you currently use both CWF and HETS to get Medicare beneficiary health insurance eligibility information, you should immediately begin to use HETS exclusively.

Please submit questions to mcare@cms.hhs.gov.

How many of you are still using the CWF for eligibility? If you’re still using it, I would love to know why in the comments.

Jan 3, 2019Payer Goddess
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Comments: 2
  1. Debra Collins
    6 years ago

    CWF is required by Blue Cross Blue Shield and other insurers when Medicare benefits exhaust and other insurance policies become the primary carrier.

    They will not accept the third party reports as proof of Medicare benefit exhaust.

    ReplyCancel
  2. Payer Goddess
    6 years ago

    If CMS goes through with this, they won’t have a choice. The Blues will have to adjust their processes a bit.

    ReplyCancel

Leave a Reply to Debra Collins Cancel reply

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