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This content is for health care providers, vendors, and clearinghouses. If you’re a person with Medicare, visit Medicare.gov.
All providers and suppliers must enroll in HETS Electronic Data Interchange (EDI) to check Medicare beneficiary eligibility. Health care providers (including suppliers), vendors, and clearinghouses work together for HETS enrollment. CMS will move to a new HETS trading partner management system in spring 2026. Complete the enrollment process to ensure continued access to HETS.
- Enrollment Information for Providers
Follow these steps to enroll in HETS:
- Work with your vendors or clearinghouses:
- Identify relationships with the vendors or clearinghouses that supports your beneficiary eligibility EDI transactions.
- Your vendor or clearinghouse will share their unique ID, which you’ll use for step 2. You can have more than 1 vendor or clearinghouse ID linked to you. You can add additional IDs at any time.
Request access to HETS:
You must have an EDI enrollment to submit Medicare Fee-for-Service (FFS) claims transactions. We’re now using the same EDI enrollment process as Medicare Administrative Contractors (MACs) and Common Electronic Data Interchange (CEDI).
When you enroll, you’ll need:
- The name of the person authorized to sign on your organization’s behalf
- Your email address (and optional alternate email address)
- Your Provider Transaction Access Number (PTAN)
- Your NPI
- Effective date of your relationship with your vendor or clearinghouse
- Termination date (if any) of your relationship with your vendor or clearinghouse
These MACs are currently accepting (or will soon accept) HETS EDI enrollment. Until all MACs accept enrollment, we run parallel HETS trading partner management systems where vendors and clearinghouses tell us the relationship they have with you.
MAC HETS EDI Enrollment Supports Jurisdictions CEDI JA, JB, JC or JD National Government Services J6 (Home Health and Hospice - HH&H) or JK (HH&H) Noridian EDISS JE or JF Novitas
JH or JL
- JH
- JL
First Coast Service Options JN Palmetto GBA
JJ or JM (HH&H)
- JJ Part A
- JJ Part B
- JM Part A
- JM Part B
- JM Home Health & Hospice
CGS
J15 (HH&H)
- J15 Part A
- J15 Part B
- J15 Home Health & Hospice
WPS (Starting December 2025) J5 or J8 Create a HETS EDI enrollment with 1 MAC for which you have an electronic claims EDI enrollment. Your MAC or CEDI will verify your claims EDI enrollment before it approves HETS access. Multiple vendor or clearinghouse IDs can be linked to a single MAC HETS EDI enrollment. It’s not required to enroll separately with each MAC for which an electronic claims EDI enrollment exists.
- Read and acknowledge the HETS Rules of Behavior (PDF)
If you don't follow these steps or don't submit electronic FFS claims, you'll lose access to HETS. You can still register to use MAC's secure internet portal to check Medicare eligibility (PDF).
Sharing Your Data Outside the U.S.
When you enroll, we’ll ask if you allow organizations outside the U.S. or its territories (“offshore organizations”) to use your NPI. Tell us if your vendor or clearinghouse shares your data with offshore organizations.
HIPAA rules don’t include requirements about business associates protecting electronic health information processed or stored outside the U.S., your risk may vary depending on geographic location.
If the third-party entity outsources work overseas, you may take on greater risks and vulnerabilities to the information. As a HIPAA-covered entity, consider these risks when conducting your risk analysis and management.
After You Enroll
- Check the monthly reports we send you detailing eligibility transactions associated with your NPI. Discuss concerns with your vendor or clearinghouse directly.
- Keep your information current, so we can send you monthly emails and contact you for recertification.
- Maintain an active HETS EDI enrollment. Starting in Spring 2026, an active HETS EDI enrollment is required for each NPI a vendor or clearinghouse submits through HETS. Without an active enrollment, HETS will reject the eligibility request.
- Work with your vendors or clearinghouses:
- Enrollment Information for Vendors & Clearinghouses
Support providers in HETS enrollment. To do this:
- Encourage providers to enroll in HETS.
- Share your HETS unique ID with your providers.
- If your organization name is incorrect in HETS, submit an updated HETS Trading Partner Agreement (PDF).
- Check the HETS Desktop (HDT) to confirm a provider’s NPI is linked to your unique ID HETS enrollment. Records update immediately. Check HDT before contacting MCARE for support.
- Help MCARE make sure that your customers maintain valid email addresses for their monthly HETS eligibility reports.
Don’t directly enroll providers in HETS. Each provider must read and acknowledge the HETS Rules of Behavior and identify their relationship with you.
Terminating Relationships
Provider and vendor or clearinghouse relationships can end:
- Providers can terminate a vendor or clearinghouse relationship by updating their HETS EDI enrollment with any MAC with which they have an electronic claims EDI agreement.
- If we contact a vendor or clearinghouse twice to have a provider update their HETS EDI enrollment inactive email address, we’ll terminate the relationship.
Resources
- Medicare Claims Process Manual, Chapter 24, Section 30 (PDF)
- Security Risks:
- Find Your MAC Jurisdiction: