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Last Modified: 6/6/2019 Location: FL, PR, USVI Business: Part A

Common working file (CWF) provider inquiries for Medicare beneficiary eligibility data

The Centers for Medicare & Medicaid Services (CMS) will add an educational message to certain Part A CWF provider inquiries (i.e., ELGA, ELGH, HIQA, and HIQH) for Medicare beneficiary eligibility data with the implementation of the July 2019 quarterly release on July 1, 2019. The message will notify users that beginning in the fall of 2019, CMS plans to terminate access to CWF eligibility queries for those who already utilize the HIPAA eligibility transaction system (HETS).
With this change, clearinghouses, third-party billers, providers, and other users will be required to press the "ENTER" key on the eligibility request screen acknowledging the message before beneficiary eligibility information will be furnished to the submitter. 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 accept the message.
As mentioned above, beginning in the fall of 2019, CMS plans to terminate access to CWF eligibility queries for those who already utilize HETS. Clearinghouses, third-party billers, providers, and other users with access to CWF and/or HETS to get Medicare beneficiary health insurance eligibility information should immediately begin using HETS.
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