Medicare HETS 270/271 Submitters:
The Health Insurance Portability and Accountability Act (HIPAA) Eligibility Transaction System (HETS) Medicare Secondary Payer (MSP) records are not current for a limited number of beneficiaries. The Common Working File (CWF), HETS’ MSP information source, implemented system changes October 7, 2019. The CWF changes inadvertently resulted in sharing beneficiary MSP updates or new occurrences with HETS only when there is claims activity. The CWF MSP data is accurate. If a beneficiary’s MSP information changed since October 7 and there hasn’t been CWF claims activity for that beneficiary, HETS MSP data isn’t current. While there is no impact to claims processing, if you submit a claim to Medicare as primary payer based on HETS inaccurate MSP data and Medicare isn’t primary payer, Medicare will deny your claim because you must bill the primary payer. However, that claim action will update HETS MSP data to reflect another payer as primary. CMS expects to correct this issue by late November.
Please contact the MCARE Help Desk if there are any questions.