{"id":7536,"date":"2026-05-06T10:24:45","date_gmt":"2026-05-06T15:24:45","guid":{"rendered":"https:\/\/pmaworks.com\/observations\/?p=7536"},"modified":"2026-05-07T06:04:49","modified_gmt":"2026-05-07T11:04:49","slug":"ask-lisa-what-the-heck-is-hets-and-other-helpful-resources","status":"publish","type":"post","link":"https:\/\/pmaworks.com\/observations\/ask-lisa-what-the-heck-is-hets-and-other-helpful-resources\/","title":{"rendered":"Ask Lisa: What the Heck is HETS? And Other Helpful Resources"},"content":{"rendered":"

SPECIAL ANNOUNCEMENT RELATING TO THIS MONTH’S ARTICLE<\/strong><\/p>\n

KMC University is hosting a live \u201cAnswer Call\u201d to help you take action now on the CMS HETS update.<\/p>\n

Keep More Cash: Don’t Let the CMS HETS Update Disrupt Your Revenue
\nPresented by:\u00a0Rebecca Scott, CPC, CPCO, CPB, CPPM<\/a>
\nDate:\u00a0TODAY! May 7, 2026
\nTime:\u00a01:00 PM – 2:00 PM (MT)
\nFor more information read their newsletter<\/a><\/p>\n

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Download the Free Template NOW<\/strong>
\nInsurance Benefits Verification Form<\/span><\/a>(docx)<\/span><\/p>\n

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.<\/p>\n

First don\u2019t panic if you received communication instructing you to register \u2026 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:<\/p>\n

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  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.)<\/li>\n
  2. You normally use your clearinghouse or EHR Program as your insurance and Medicare benefits verification tool.<\/li>\n<\/ol>\n

    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.<\/p>\n

    You may be now asking\u2026 What are the best third-party payer verification tools? Here\u2019s a current breakdown for you:<\/p>\n

    Medicare Verification: Connex is CMS Medicare\u2019s Portal to use to verify eligibility and benefits, and claims. If you do not have a Connex account you have two options:<\/p>\n

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    1. Apply for an account Here<\/span><\/a><\/li>\n
    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<\/span><\/a><\/li>\n<\/ol>\n

      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\u2019s 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.<\/p>\n

      Major Commercial Payers:<\/p>\n