The purpose of this message is to clearly communicate the Medicare HETS 270/271 Eligibility system approach to ensure compliance with the Health Insurance Portability and Accountability Act's (HIPAA's)new version of the Accredited Standards Committee (ASC) X12 Electronic Data Interchange (EDI) transactions.
The Accredited Standards Committee made corrections to the 5010 versions of certain transactions. The Errata versions replace the Base versions for HIPAA compliance. Per the Federal Register (Vol. 75, No. 197, October 13, 2010, 62684 "62686 [2010 "25684]. The link to this can be found in the "Related Links Outside CMS" section below.), HIPAA compliance will require the implementation of the Errata versions. Compliance with the Errata must be achieved by the original regulation compliance date of January, 2012. The Base Version of the 270/271 Health Care Eligibility Benefit Inquiry and Response is the 005010X279 version. The Errata version is the 005010X279A1 version.
Medicare HETS 270/271 will implement the Errata versions to meet HIPAA compliance requirements. Also in compliance with the published regulation (RIN 0938-AM50 of 45 CFR Part 162), Medicare HETS 270/271 testing with Submitters must be available to begin testing in January of 2011.
MCARE will be ready to test the Base version (005010X279) of the Medicare eligibility 270/271 transaction in January 2011, and the Errata (005010X279A1) version in April 2011. Submitters will be able to submit a limited number of test transactions to both the Base and Errata versions. HETS 270/271 Submitters should contact MCARE effective January 2011 to discuss testing schedules. 5010 Base version testing is optional; Submitters may choose to wait until the Errata version is implemented in April 2011 to begin testing.
The Errata (005010X279A1) version will be available for Medicare production in April 2011. The Errata transactions must be tested before using them for production. As a result, HETS 270/271 5010 test-to-production transition will begin in April 2011. Submitters will not be able to move to production under the 5010 Base versions - only the Errata version will be used for production transactions. All HETS 270/271 Submitters must complete the migration to the production Errata (005010X279A1) version by January 1, 2012. Effective that date, the current 4010A1 HETS 270/271 system will no longer be available.
Additional information about the HETS 270/271 5010 migration (including the HETS 5010 Companion Guide and migration analysis documents) are available on the CMS HETSHelp website. A link to this webpage can be found in the "Related Links Inside CMS" section below.
Medicare Customer Assistance Re: Eligibility (MCARE) Help Desk