SPECIAL ANNOUNCEMENT RELATING TO THIS MONTH’S ARTICLE

KMC University is hosting a live “Answer Call” to help you take action now on the CMS HETS update.

Keep More Cash: Don’t Let the CMS HETS Update Disrupt Your Revenue
Presented by: Rebecca Scott, CPC, CPCO, CPB, CPPM
Date: TODAY! May 7, 2026
Time: 1:00 PM – 2:00 PM (MT)
For more information read their newsletter

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Insurance Benefits Verification Form(docx)

If you have received communications from Medicare regarding HIPAA Eligibility Transaction System (HETS) requirements, keep reading for information that will be helpful as you navigate if this applies to you.

First don’t panic if you received communication instructing you to register … HETS is only a beneficiary eligibility tool that will sync within your Clearinghouse or EHR Program, and may apply to you only if both of these scenarios exist in your office:

1. Insurance Verifications are part of your practice operations. (Verifying is a key component to your revenue cycle and keeping you in the know for your patient financial consultations.)
2. You normally use your clearinghouse or EHR Program as your insurance and Medicare benefits verification tool.

If you do not pay extra for and do not have the benefits eligibility verification service with your clearinghouse or EHR Program, HETS is not applicable to your office.

You may be now asking… What are the best third-party payer verification tools? Here’s a current breakdown for you:

Medicare Verification: Connex is CMS Medicare’s Portal to use to verify eligibility and benefits, and claims. If you do not have a Connex account you have two options:

1. Apply for an account Here
2. Add this service to your Clearinghouse contract for an extra fee. If you go this route, you will need to follow the HETS policy and procedure. Learn more here: HETS

Medicaid Verifications: Each state has its own Medicaid Portal/website for checking eligibility in advance of treating your patient. Use your favorite search engine to search for your state’s Medicaid online Portal website. Keep in mind each website may have a different default browser that works better; for example, Google Chrome may sync better with the site vs. MS Edge.

Major Commercial Payers:

• UHC/Optum/AARP: Verify here UHC Optum or call the Provider Line on the patient insurance card. Make sure to get the representative’s name and a call reference number if you need to follow up on a claim once the remittance comes back.
• UMR: Verify here UMR or call Provider Line on the patient insurance card. Make sure to get the representative’s name and a call reference number if you need to follow up on a claim.

Use Availity Portal for patient benefits and eligibility: Availity

Currently for these payers:

• Aetna
• BCBS Plans, most states
• Humana
• CIGNA
• Well Care for Medicare/Medicaid

Implementing and maintaining patient benefits verification will help you plan ahead for your financial consultations which is an important part of managing your revenue cycle and generating income.

Follow-Up Questions? Just Ask…

Lisa
920-334-4561

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