The Centers for Medicare & Medicaid Services (CMS) is reminding providers and organizations, that use the HIPAA Eligibility Transaction System (HETS) 270/271, to keep the email address associated with their HETS Electronic Data Interchange (EDI) enrollment current.

HETS provides real-time Medicare beneficiary eligibility information through HIPAA-compliant 270 eligibility requests and 271 responses. Providers may access these transactions through software vendors, billing companies, electronic health record or practice management systems, and EDI clearinghouses.

Why the Email Address Matters

CMS reports that HETS will monitor failed delivery of enrollment-related email. If email delivery fails for three consecutive monthly attempts—October 1, November 1, and December 1, 2026—the HETS EDI enrollment may be suspended. Once suspended, HETS can reject eligibility requests submitted for the associated NPI until the email address is corrected through the provider’s Medicare Administrative Contractor (MAC), for Connecticut this is Wellpoint Federal.

Providers should take action if their clearinghouse reports an email-delivery failure or if they do not receive an expected monthly HETS transaction count report after completing HETS EDI enrollment. A billing company, EHR vendor, or clearinghouse cannot update the enrollment email for the provider; the correction must be made through the MAC.

What Providers Should Do

1. Confirm that the email address listed on the HETS EDI enrollment is accurate and monitored.
2. Watch for HETS transaction count reports and any delivery-failure notifications from vendors or clearinghouses.
3. If the enrollment email needs to be changed, contact the appropriate MAC promptly rather than waiting until the December 1 deadline.
4. Confirm that each NPI used for HETS eligibility verification has a valid HETS EDI enrollment.
   • This is separate from the HETS EDI enrollment requirement that took effect May 11, 2026.
5. Taking these steps can help prevent an avoidable interruption in real-time Medicare eligibility verification.

Sources

CMS, MLN Connects Newsletter, October 8, 2026

CMS, HETS2026-4 Release Summary

CMS, HETS EDI: How to Enroll

CMS, HIPAA Eligibility Transaction System (HETS)

Michele Krpata, BSW, CPC, CPMA

Compliance Officer, Quality Reporting Analyst

Integrated Physicians Management Services