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CMS Eligibility - HIPPA Eligibility Transaction System (HETS) FAQ

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This article explains upcoming changes to the HIPAA Eligibility Transaction System (HETS), a service from the Centers for Medicare & Medicaid Services (CMS) used to verify Medicare beneficiary eligibility. CMS is transitioning to a new HETS trading partner management system, and action is required to ensure continued access to Medicare eligibility checks through RXNT. 

Important information

To continue checking Medicare eligibility through RXNT after May 11, 2026, providers must:

  • Complete HETS EDI enrollment through their MAC
  • Link their NPI to Optum Submitter ID VQAS
  • Ensure enrollment is active before submitting eligibility requests

Failure to complete this process will result in rejected eligibility transactions and temporary CMS access restrictions.

What is changing with CMS HETS?

CMS is implementing a new HETS trading partner management system that requires updated enrollment validation for Medicare eligibility requests.

Starting May 11th, 2026, CMS will require an active HETS EDI enrollment for each NPI submitted through HETS. Without this enrollment, eligibility requests will be rejected.

What action is required by May 11, 2026?

Providers must complete the required HETS EDI enrollment or attestation process through their assigned Medicare Administrative Contractor (MAC) and ensure their NPI is linked to:

Optum Submitter ID: VQAS

Failure to complete this process will result in rejected Medicare eligibility requests and a temporary CMS block on further eligibility checks.

What happens if enrollment is not completed?

If HETS EDI enrollment is not active:

  • Medicare eligibility requests submitted through RXNT will be rejected
  • Rejections will be due to authorization or access restrictions
  • CMS will block additional eligibility checks for 24 hours after rejection
RXNT cannot override or complete this enrollment on your behalf.

What do I need to complete the enrollment or attestation?

The information requested may vary depending on your Medicare Administrative Contractor, also known as your MAC. When completing the HETS EDI enrollment or attestation, you may be asked the following:

  • Authorized signer name
  • Email address
  • Provider Transaction Access Number (PTAN)
  • Individual or Group NPI used for Medicare billing
  • Effective date of vendor/clearinghouse relationship
  • Termination date (if applicable)
  • Unique HETS ID or Submitter ID

Important:
If you enrolled in Medicare claims using a group provider number, CMS requires you to use the same group number for HETS enrollment.

Where do I complete the HETS enrollment?

Enrollment must be completed through your assigned Medicare Administrative Contractor (MAC).

Below are MAC-specific enrollment and attestation links:

How do I know which MAC applies to my practice?

Your MAC is determined by:

  • Medicare enrollment location
  • PTAN
  • State
  • Line of business

If you are unsure, verify your MAC through your Medicare enrollment documentation before completing attestation.

Who can I contact for help?

Contact your MAC directly for enrollment assistance:

  • NGS:
    • J6: (877) 273-4334
    • JK: (888) 379-9132
    • CEDI: (866) 311-9184
  • Noridian:
    • E: (855) 609-9960
    • F: (877) 908-8431
  • First Coast Service Options (J N):
    • (888) 664-4112
  • Novitas:
    • JH: (855) 252-8782
    • JL: (877) 235-8073
  • Palmetto GBA:
    • JJ: (877) 567-7271
    • JM: (855) 696-0705
  • CGS:
    • J15 Part A: (866) 590-6703
    • J15 Part B: (866) 276-9558
    • HH&H: (877) 299-4500

Can RXNT complete this process for me?

No. RXNT cannot complete HETS EDI enrollment or attestation on behalf of providers. However, RXNT support can assist with locating relevant payer or enrollment information within the system.

For all attestation form questions, MAC login issues, or CMS requirements, please contact your MAC directly.

Additional information

Submitted before HETS attestation is active

If a Medicare eligibility request is submitted before the HETS attestation is active, CMS may temporarily block additional Medicare eligibility requests for approximately 4 hours.

The 4-hour block starts from the time the first eligibility request fails due to missing or inactive attestation. Completing the attestation does not immediately remove the block.

For example, if a Medicare eligibility request is submitted at 12:00 PM CT before attestation is active, Medicare eligibility may remain blocked until approximately 4:01 PM CT, even if the provider completes attestation during that time.

Once the 4-hour block expires:

  • If attestation has been completed, Medicare eligibility should process successfully.
  • If attestation has not been completed and another Medicare eligibility request is submitted, the 4-hour block may restart.

Customers may see different messages, and the next step depends on the message shown.

Authorization/Access Restrictions

This usually means the HETS attestation is missing, inactive, or not tied to the NPI being used for the eligibility check.

Customer action:

  • Confirm the HETS attestation was completed with their MAC.
  • Confirm the correct NPI was used for attestation.
  • Confirm the same NPI is entered in RXNT Utilities for eligibility.
  • If attestation was completed recently, wait for the temporary block to expire before trying again.

Eligibility requests cannot be resubmitted for X hours and X minutes

This means Medicare eligibility is temporarily blocked because a request was submitted before attestation was active.

Customer action:

  • Wait until the timer has passed.
  • Do not submit another Medicare eligibility request until the timer expires.
  • Confirm the HETS attestation was completed.
  • Confirm the Eligibility NPI in RXNT matches the NPI used for attestation.

RXNT cannot override this timer.

Unable to respond at the current time. 

Customer action:

  • Contact RXNT Support.
  • Provide the date and time of the eligibility check.
  • Provide the patient example.
  • Provide a screenshot of the error message.

If you see a NoHetsAttest message after completing attestation

This applies only if the HETS attestation is already completed and the customer is credentialed with Medicare under the Group/Billing NPI. 

After completing the HETS attestation using Optum Submitter ID VQAS, Medicare eligibility may not work immediately.

If an eligibility check is submitted before the attestation is fully recognized, RXNT may show a rejection similar to:

  • Reject Reason: Authorization/Access Restrictions
  • Follow-Up Action: Please Correct and Resubmit
  • Detailed Message: Code - NoHetsAttest01 - Eligibility requests cannot be resubmitted for X hours and X minutes

This means the eligibility request was temporarily blocked because the HETS attestation was not recognized at the time the eligibility request was submitted.

Optum has advised that customers may need to wait up to 4 hours after completing attestation before trying again. The message will usually show how much time is left before another eligibility request can be submitted.

Customers should wait until the time has passed before submitting another Medicare eligibility request.

Confirm the Eligibility NPI in RXNT Utilities

If the practice completed the HETS attestation under the Group NPI or Billing NPI, the Eligibility NPI in RXNT should match that NPI.

For Billing, customers should go to:

  1. Utilities  
  2. Providers  
  3. Rendering Providers

On the Rendering Provider Profile, confirm:

  1. Enable Eligibility NPI is selected
  2. The Eligibility NPI matches the NPI used for the HETS attestation
  3. If the practice is credentialed under the Group/Billing NPI, the Eligibility NPI should be the Group/Billing NPI, not the rendering provider’s individual NPI

For Scheduling, customers should go to:

  1. Utilities 
  2. Company Setup 
  3. Person Resources

On the Person Resource profile, confirm:

  1. Eligibility Resource Entity Type is set correctly
  2. If eligibility should be checked under the practice or group, select Non-Person Entity
  3. The Eligibility NPI matches the NPI used for the HETS attestation
This is important when Medicare eligibility works in Billing but not in Scheduling. In those cases, you may have the correct NPI in Billing, but the Scheduling resource may still be set to the rendering provider’s individual NPI instead of the Group/Billing NPI. 


 

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