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The HIPAA Eligibility Transaction System (HETS) is intended to allow the release of eligibility data to Medicare Providers, Suppliers, or their authorized billing agents for the purpose of preparing an accurate Medicare claim, determining Beneficiary liability or determining eligibility for specific services.
Use the information in the eligibility response to prepare accurate Medicare claims, determine patient liability, or check eligibility for specific items or services. Check when your patients are eligible for preventive services. When you know past dates of service or next eligible dates, you can:
need to know if your patient is eligible for medicare? To ensure you are billing appropriately for Medicare-covered supplies and services, check for eligibility. Regularly review your patients’ eligibility information.
This page contains information on Medicare Part A and Medicare Part B eligibility and enrollment. For more information about Medicare for people who are still working, go to our Employer page or I’m 65 and Still Working page.
View a beneficiary’s Medicare eligibility including Part A and B entitlement, HMO, MSP, Inpatient/SNF episodes and more
Get an estimate of when you're eligible for Medicare and your premium amount. If you don't see your situation, contact Social Security (or the Railroad Retirement Board if you get railroad benefits) to learn more about your specific eligibility or premium. We don't store your information.
This product informs health care professionals and administrative staff about checking Medicare eligibility. It’s useful for physicians, non-physician practitioners, health care administrators, medical coders, billing and claim processing personnel, and other medical administrative staff responsible for submitting claims for payment.
Eligibility for Medicare coverage depends on factors that include your work history, health status, and residency status. Check your eligibility today.
CMS requires providers to use the interactive voice response (IVR) Systems to access claim status and beneficiary eligibility information. For step-by-step instructions on how to use the IVR, please visit the Self-Service Tools page of our website.
Use the eligibility response to prepare accurate Medicare claims, determine patient liability, or check eligibility for specific services. Each MAC ofers its own Medicare online provider portal so you can access information anytime. Find your MAC’s website to register for your MAC’s portal.