A recent policy change by the Centers for Medicare & Medicaid Services (CMS) introduces a meaningful shift in how access to Medicare eligibility data is governed. While framed as an operational update, the change has clear security and compliance implications for providers, revenue cycle management (RCM) companies, and clearinghouses.
At the center of this update is the Medicare Health Eligibility Transaction System (HETS)—a critical infrastructure used to verify patient eligibility via standard 270/271 EDI transactions. For many organizations, HETS is deeply embedded in front-end workflows, making uninterrupted access essential for revenue continuity.
What Changed — and Why It Matters for Security
CMS has eliminated the ability for third-party vendors—including RCM companies—to complete annual HETS attestations on behalf of providers.
Effective May 11, 2026:
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