AI-Driven Automation Tools
Resupply, Rental, and POS Workflows
Delivery Management and Mobile App
HETS stands for HIPAA Eligibility Transaction System. It is the Centers for Medicare and Medicaid Services (CMS) system that processes real-time 270/271 eligibility transactions — the electronic requests your DME billing software sends to verify whether a Medicare beneficiary is covered before you deliver equipment or submit a claim.
For DME suppliers and HME providers across the United States, real-time Medicare eligibility verification through HETS is one of the most important parts of a clean claims process and an efficient revenue cycle management (RCM) workflow. Without it, your billing team is submitting Medicare claims without first confirming active coverage, the correct plan details, or applicable deductibles and co-insurance amounts.
Think of HETS as the gateway to real-time Medicare data. Every time your DME billing software checks a beneficiary's coverage — before a wheelchair, CPAP machine, oxygen concentrator, or any other durable medical equipment is delivered — that check goes through HETS. If your enrollment lapses or is never completed, that gateway closes.
Key HETS facts for DME providers:
CMS has mandated a significant change to how providers access the HIPAA Eligibility Transaction System. Previously, providers accessed HETS through their clearinghouses or billing vendors without completing a formal individual enrollment. That is no longer the case.
Under CMS Internet-Only Manual Publication 100-04, Chapter 24, Section 30, all Medicare Fee-for-Service providers must now complete a formal HETS EDI enrollment through their Medicare Administrative Contractor (MAC) or Common Electronic Data Interchange (CEDI).
This enrollment process requires you to:
Deadline: May 11, 2026.
Starting May 11, 2026, any provider whose NPI is not linked to an active HETS EDI enrollment will receive an AAA*41 response code — meaning Authorization/Access Restrictions — on every Medicare eligibility request. This response code blocks all real-time eligibility transactions until the provider completes enrollment.
This requirement applies to every DME supplier, HME provider, home health agency, hospice, and Medicare Part A/B provider that submits electronic claims or uses a billing platform, clearinghouse, or software vendor to run eligibility checks. There is no opt-out and no grace period after the deadline.
Source: CMS.gov — HETS EDI: How to Enroll | CMS MLN Connects Newsletter, April 30, 2026
You are required to complete HETS EDI enrollment if any of the following apply to your organization:
Important: Using a billing platform or clearinghouse does not automatically enroll you. Curasev, for example, submits eligibility transactions on your behalf — but CMS requires that you, as the provider, complete this enrollment to certify the vendor relationship. It is your responsibility as the NPI holder to ensure this is done before May 11, 2026.
Critical note on group NPIs: If your organization signed up for electronic claims submission using a group provider number, you must use that same group NPI when completing your HETS EDI enrollment. CMS requires consistency between your EDI claims enrollment and your HETS enrollment. Using the wrong NPI will cause your application to fail validation.
Not all Medicare Administrative Contractors have opened their HETS EDI enrollment portals at the same time. CMS maintains an updated table on its website showing which MACs are currently accepting submissions.
Before doing anything else, check this table: View the MAC Enrollment Table on CMS.gov
If your MAC is not yet listed as ready, bookmark the page and check it daily. The table updates as each MAC opens enrollment. Do not wait until the last minute — if your MAC opens enrollment close to the May 11, 2026 deadline, you want to be ready to act immediately.
If you are unsure which MAC handles your Medicare claims, CMS provides jurisdiction maps for every provider type. Use the correct map for your provider category:
Your MAC jurisdiction is determined by the state in which your practice or business is located. DME suppliers operating across multiple states should note that they only need to create one HETS EDI enrollment with one MAC — the MAC does not need to match every jurisdiction where you submit claims.
Once your MAC is accepting HETS EDI enrollments, log in to your MAC's secure provider portal or the CEDI portal. Each MAC has its own interface, but the process follows a standard format set by CMS.
Common MAC portals used by DME suppliers include:
Log in using your existing MAC portal credentials. If you do not have portal access set up, contact your MAC directly to establish an account before attempting enrollment.
During enrollment, you will be asked to identify each clearinghouse or billing vendor that submits HETS eligibility requests on your behalf. You must enter each vendor separately using their unique HETS ID.
If you use Curasev for real-time Medicare eligibility verification, enter exactly:
Inovalon is Curasev's clearinghouse partner for Medicare eligibility transactions. Inovalon does not share your NPI or any Protected Health Information (PHI) with offshore organizations.
You can add multiple clearinghouses to a single enrollment. If you use more than one billing vendor or clearinghouse for Medicare eligibility, each one must be submitted separately with its own unique HETS ID. You may add additional vendor IDs at any time after your initial enrollment.
CMS requires that an authorized signer at your organization read and formally acknowledge the HETS Rules of Behavior as part of the enrollment process. This is a compliance attestation confirming that your organization will use HETS eligibility data appropriately, in strict accordance with HIPAA regulations, and only for authorized Medicare-related purposes.
This is not a formality — it is a legally binding attestation. The authorized signer must be an individual with the authority to bind your organization to these terms.
Once you submit your completed attestation, CMS updates HETS immediately. There is no processing delay or waiting period. Your MAC does not need to manually approve the submission — the record is updated in real time in the HETS Desktop (HDT) system.
After submission, you do not need to make any changes in Curasev or your billing software. Your eligibility transactions will continue without interruption as long as you have submitted the correct vendor HETS ID (VQAS for Curasev / Inovalon).
You can verify the enrollment is active by checking the HETS Desktop (HDT) — the system will show your NPI linked to the correct vendor Unique ID.
Based on the most common questions from DME suppliers, billing managers, and revenue cycle teams, here are the enrollment errors you must avoid:
1. Using the wrong NPI.If you enrolled for electronic claims submission using a group NPI, you must use that same group NPI for HETS EDI enrollment. Using an individual NPI when the claims enrollment is under a group NPI will cause validation to fail.
2. Not enrolling because you use a clearinghouse.Many DME providers assume that their clearinghouse or billing vendor handles enrollment on their behalf. CMS explicitly prohibits vendors from directly enrolling providers. You must complete this step yourself.
3. Missing vendors in your enrollment.If you use more than one clearinghouse or billing vendor for Medicare eligibility, each one must be linked separately. A common mistake is enrolling only the primary clearinghouse and forgetting about a secondary vendor used for specialty equipment lines.
4. Waiting too long.The May 11, 2026 deadline is firm. Providers who attempt to enroll in the final days before the deadline risk delays if their MAC portal experiences high traffic or if there are issues with their PTAN/NPI validation.
5. Not confirming the vendor's Unique ID.Every clearinghouse and billing vendor has a specific HETS Unique ID assigned by CMS. Entering the wrong ID will result in a failed relationship link. Always confirm the correct ID directly with your vendor before starting enrollment. For Curasev users: VQAS.
Curasev is a purpose-built DME billing software and revenue cycle management platform designed for durable medical equipment and home medical equipment providers. Unlike general-purpose billing tool such as Curasev is built from the ground up for the specific workflows, compliance requirements, and payer relationships that define the DME and HME industry in 2026.
Curasev integrates real-time 270/271 Medicare eligibility verification directly into your order workflow — so your team can confirm a beneficiary's coverage, deductibles, and plan details at the exact moment an order is placed, before any equipment leaves your facility and before any claim is submitted.
What this means for your revenue cycle:
By completing your HETS EDI enrollment before May 11, 2026 — and entering VQAS as Curasev's HETS Unique ID — you ensure uninterrupted access to real-time Medicare eligibility data inside the Curasev platform. Your eligibility transactions will continue without interruption, protecting your billing team's efficiency and your revenue cycle.
For any questions specific to your HETS EDI enrollment, contact your Medicare Administrative Contractor directly using the contact information on their secure provider portal.
Disclaimer: The information in this article is provided for general informational purposes only and does not replace, modify, or supersede official guidance from CMS. Each provider is responsible for understanding and complying with all applicable CMS rules, regulations, and system usage requirements.
Stop forcing your team to work around outdated software. Our end-to-end platform is built to mirror your specific HME workflow—from the first referral intake to the final collection.
.png){kind=icon}
