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Last Modified: 12/13/2017 Location: FL, PR, USVI Business: Part A, Part B

HETS application: Hospital spell dates and Part A and B free services

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 impacted 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.

Change to hospital spell dates

HETS responses now return the date of earliest billing action (DOEBA) and date of latest billing activity (DOLBA) dates of all hospital spells intersecting the current date and/or the calendar (years) of the date/date range of the request. This data now returns in the response regardless and is not contingent on any specific service type code (STC) or Healthcare Common Procedure Coding System (HCPCS) code in the request. This assists providers in recognizing hospital spells and the billing dates in order to determine eligibility.

Change to Part A and Part B free services

HETS responses now return the Part A free services date(s) with the potential for multiple DTP segments, regardless of what calendar year they fall within. Similarly, HETS responses now return the Part B free services date(s) with the potential for multiple DTP segments, regardless of what calendar year they fall within. Finally, both Part A and Part B free services now only return for non-QMB periods. This assists providers in recognizing free service dates for beneficiaries and their eligibility for those services.
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.