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Health Insurance Query Access (HIQA) Eligibility Changes

For All Medicare Part A Submitters

With the implementation of the July 2019 quarterly release, CMS will add an educational message to certain Part A Common Working File (CWF) Provider Inquiries (i.e., ELGA, ELGH, HIQA, and HIQH) for Medicare beneficiary eligibility data. This message will notify users that beginning in the fall of 2019, CMS plans to terminate access to CWF eligibly queries for those who already use HIPAA Eligibility Transaction System (HETS).

Before beneficiary eligibility information will be furnished, clearinghouses, third-party billers, providers and other users must press "ENTER" on the eligibility request screen to acknowledge the message. This change will affect individuals and organizations using the CWF Provider Inquiry screens and will require organizations that use screen scraping and/or other automation methods to obtain beneficiary eligibility information via the CWF to modify their programs, if necessary, to access the message.

Effective immediately, those affected by this change should get Medicare beneficiary health insurance eligibility information using HETS. To do so, please register for the Noridian Medicare Portal (NMP). Access registration information from the NMP webpage.

Message Sent:
June 4, 2019