skip to content
Thank you for visiting First Coast Service Options' Medicare provider website. This website is intended exclusively for Medicare providers and health care industry professionals to find the latest Medicare news and information affecting the provider community.
To enable us to present you with customized content that focuses on your area of interest, please select your preferences below:
Select which best describes you:
Select your location:
Select your line of business:
This website provides information and news about the Medicare program for health care professionals only. All communication and issues regarding your Medicare benefits are handled directly by Medicare and not through this website. Information for Medicare beneficiaries is only available on the medicare.gov website.
En Español
Text Size:
Send a link to this page
[Multiple email adresses must be separated by a semicolon.]
Last Modified: 12/13/2017 Location: FL, PR, USVI Business: Part A, Part B

HETS application: QMB financial data and hospice occurrence count

The Centers for Medicare & Medicaid Services (CMS) released several changes to the Health Insurance Portability and Accountability Act (HIPAA) Eligibility Transaction System (HETS), which went into effect November 4, 2017. The changes impact providers who use First Coast Service Options’ (First Coast’s) Secure Provider Online Tool (SPOT) to access eligibility data through HETS. The eligibility display in SPOT now includes a tab titled QMB, or qualified Medicare beneficiary.

QMB periods in the 271 will result in changes to non-QMB period 271 financial data

Financial data in the HETS 271 response now appears differently for non-QMB periods for Medicare beneficiaries that have at least one QMB period intersecting the current date and/or the calendar (years) of the date/date range of the 270 request. QMB periods are returned as separate entitlement periods with independent financial details. Non-QMB periods returned on the 271 response are adjusted to illustrate that they are separate from a QMB period. This change in display function allows providers to easily see when a patient is eligible for QMB and when they are not eligible, and the financial details associated with both cases.

Change to 271 hospice occurrence count

HETS 271 responses only include the hospice occurrence count if the Medicare beneficiary has Part A entitlement. If the Medicare beneficiary does not have Part A entitlement, the hospice occurrence count benefit is not returned on the 271.
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.