Medicare Eligibility Checks: HETS Eligibility Attestation May Be Necessary
CMS mandates that all providers using third-party vendors (clearinghouses, EHRs) for Medicare eligibility checks need to file an attestation by May 11, 2026. This may include eligibility checks performed through a clearinghouse, or through billing software, a practice management system, or another vendor connected to your Medicare workflow.
This matters because many offices use electronic Medicare eligibility checks to confirm benefits before a visit, verify information entered by staff, or double-check patient-provided coverage details. If that electronic process relies on CMS HETS, the office may need to complete an attestation or enrollment step so the clearinghouse or vendor remains linked to the office’s Medicare billing NPI.
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Check With Your Clearinghouse
For most practices, the clearinghouse is the best place to start. Even when eligibility appears to run through your practice management or billing system, the actual Medicare eligibility transaction may be routed through a clearinghouse or other third-party vendor.
CMS describes the requirement this way: “Providers using third-party vendors to check Medicare beneficiary eligibility must now enroll these vendors with CMS for HIPAA Eligibility Transaction System (HETS) access by linking each vendor to your NPI.”
In a separate HETS enrollment resource, CMS states that “All providers and suppliers must enroll in HETS Electronic Data Interchange (EDI) to check Medicare beneficiary eligibility.” CMS also notes that providers, vendors, and clearinghouses work together for HETS enrollment.
The key question is simple: “What do we need to do to comply with the CMS HETS enrollment requirements with you?”
Some Clearinghouses may have a warning message in your portal that will guide you to and through the process of attestation or enrollment.
Does This Impact Your Practice?
Your office should review this issue if you check Medicare eligibility electronically rather than manually. Electronic checks are often used before or during a patient visit, as part of the intake workflow, or to confirm information entered by staff.
You may run these transactions through your clearinghouse (directly), billing software, practice management system, or another third-party vendor. If your office only checks eligibility manually through the Medicare Administrative Contractor’s secure portal, this HETS vendor-linking issue may not apply.
Check with your clearinghouse to confirm the impact on your practice.
CMS Resources
CMS MLN Connects, HETS Action Required: Enroll Third-Party Vendors for Access by May 11
CMS HIPAA Eligibility Transaction System (HETS)
For HETS questions, CMS lists the MCARE Help Desk at mcare@cms.hhs.gov or 1-866-324-7315.
