Current Medicare HETS Eligibility Issues

Below is a list of outstanding issues that CMS is on working for the HETS eligibility response. If you’re using eligibility from a vendor (Experian, Change Healthcare, Availity, etc) this is the response you’re receiving. This is also the connection everyone will be required to use once CMS sunsets the CWF eligibility functions.

Table 1. Open HETS Data Issues Current Data Issues	Percentage of Impacted Medicare Beneficiaries	Date that a Fix is Planned	Detailed Description of the Issue
HETS may be returning incorrect Hospice episode information or occurrence counts when the Medicare Beneficiary has a new Notice of Election (NOE) and had billed Hospice episodes four or more years ago.	1%	October 2019	HETS’ data source for Hospice information is the Common Working File (CWF). CMS has identified an issue where CWF is sending an incorrect Hospice information to other systems (including HETS) when the Medicare Beneficiary has a new Notice of Election (NOE) and previously billed hospice periods. CWF updates the file and corrects the Hospice history once a Hospice claim is processed for the new billing period. CWF will update their database and processes to resolve these discrepancies and prevent future occurrences.
After the Medicare Beneficiary received the first Pneumococcal Vaccine (PPV), CWF is not sending the eligibility information for the second PPV vaccine to HETS.	33%	Q1 2020	HETS’ data source for prior PPV usage is the Common Working File (CWF). HETS returns PPV vaccination data using CWF records for HCPCS 90670 and 90732. HETS correctly returns the PPV vaccination next eligible dates for both HCPCS if the Medicare Beneficiary has never been vaccinated. When the HETS 271 returns no next eligible date available for PPV, the Medicare Beneficiary may have actually only received one of the PPV vaccines and may still be eligible for the second vaccine after a year between deliveries. CMS encourages Providers to discuss the Pneumococcal vaccine and any previous receipt of that vaccine with your patients.
CMS has identified a more accurate source of data for End Stage Renal Disease (ESRD) Dialysis Start Date and ESRD Dialysis End Date.	1%	August 2019	HETS currently returns ESRD information on the 271 response when Service Type Code ‘CQ’ or ‘RN’ are included in the 270 request. CMS has identified an issue with the data source used for the End Stage Renal Disease (ESRD) Dialysis Start Date and ESRD Dialysis End Date. CMS is working to correct this issue quickly. In the interim, CMS encourages dialysis clinics to co-ordinate with each other to get correct Dialysis Start Dates for the coordination of the Medicare Beneficiary’s dialysis training. CMS will modify its data source to utilize the improved data. The format of the ESRD data in the 271 response will be exactly the same as is currently in use.