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.

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

What do I need to complete the enrollment or attestation?

When completing the HETS EDI enrollment, you may need 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)

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:

• DME MAC / CEDI: HETS CEDI Enrollment Form
• National Government Services (J6 & JK): NGS HETS Attestation Form
• First Coast Service Options (J N): FCSO HETS EDI Enrollment Tool
• Novitas (JH): Novitas JH HETS EDI Enrollment
• Novitas (JL): Novitas JL HETS EDI Enrollment
• Noridian (E & F): EDISS Connect
• Palmetto GBA (JJ Part A): Palmetto JJ Part A EDI
• Palmetto GBA (JJ Part B): Palmetto JJ Part B HETS Guide
• Palmetto GBA (JM Part B): Palmetto JM Part B EDI Tools
• Palmetto GBA (JM HH&H): Palmetto JM Home Health & Hospice
• CGS (J15 A, B, HH&H): CGS HETS EDI Enrollment
• WPS (J5 & J8): WPS HETS Provider Attestation

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.