Aetna will be making the changes below to their eligibility response on February 8th. Pay particular attention to the first one. If your eligibility vendor hasn’t changed their system to stop allowing member ID searches without a DOB, you’ll get a DOB error.
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 firstname.lastname@example.org.
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.
CMS has announced several upcoming changes to the Medicare eligibility response. The release is scheduled for 12/8 and the system won’t be available from 7:00 am to 7:00 pm Saturday as they complete this release. I’ve listed a summary of the changes below but the complete release notes can be found here.
CMS may potentially return the following codes based on the beneficiaries previous usage: G9873, G9874, G9875, G9876, G9877, G9878, G9879, G9880, G9881, G9882, G9883, G9884, G9885, G9890 and G9891.
Please see the changes Aetna just announced for their August 10th release.The network identification change will be a great addition.
Eligibility and Benefits Inquiry (270/271):
We’ll make the following changes:
Claim Status Inquiry (276/277):
We’ll make the following change:
CMS sent out the notice below last week in MLN. they have still not decided to allow vendors like Change Healthcare, Availity, or Experian Health to access this tool. If a Medicare beneficiary presents without their new card and they’re in one of the states that has received their cards, you will have to log onto the MACs site to find the new number.
All Medicare Administrative Contractor (MAC) secure portal Medicare Beneficiary Identifier (MBI) look-up tools are ready for use. If you don’t already have access, sign up for your MAC’s portal to use the tool.
Submit four data elements about your patient through the tool, and we will return the MBI if we have already mailed the new Medicare card. Medicare is mailing new cards in phases by geographic location. For more information about the MBI, read the MLN Matters® Special Edition Article.
We are currently mailing new cards to people who:
CMS will be making the following changes their eligibility response this month.
• Medicare Beneficiary Demographics
• Date of Death
• Unlawful Occurrences
• Medicare Part B Entitlement
• MDPP Coverage
• MDPP Financial Information
• Medicare Advantage Enrollment(s)
• Medicare as a Secondary Payer (MSP) Enrollment(s)