Samuel A. Collins
I hope you did not panic over the May 11, 2026 deadline regarding HETS (HIPAA Eligibility Transaction System), the new portal for Medicare eligibility verification. While registration for the new portal is important, whether or not you registered by that date does not affect the submission or payment of Medicare claims.
However, these new requirements are still significant because failure to comply could eventually interrupt the ability to verify Medicare eligibility electronically.
Although many chiropractic offices may not access HETS directly, nearly every office that verifies Medicare eligibility electronically through a clearinghouse, billing service, EHR, or practice management system is impacted by these changes.
What Is HETS?
The HIPAA Eligibility Transaction System is the Medicare electronic eligibility verification system used for:
- Real-time Medicare eligibility verification
- Deductible information
- Secondary payer information
- Coverage effective dates
- Medicare Advantage participation information
- Service eligibility inquiries
Most chiropractic offices interact with HETS indirectly through clearinghouses, EHR systems, practice management software, billing services, and revenue cycle vendors. When a staff member checks Medicare eligibility electronically, the inquiry commonly routes through HETS.
What Changed?
CMS is transitioning to a new HETS Trading Partner Management System, and tightening security and authorization requirements. Historically, many clearinghouses and vendors could perform eligibility checks using provider NPIs without a formal provider attestation process.
As of this year, CMS now requires active HETS EDI enrollment for each provider / supplier NPI, provider acknowledgment and authorization of vendors / clearinghouses accessing HETS data, and formal relationship tracking between providers and vendors for ongoing enrollment maintenance and monitoring.
Why CMS Made the Change
CMS has indicated the changes are designed to improve cybersecurity, prevent unauthorized use of provider NPIs and improve audit tracking of third-party eligibility access. CMS is essentially requiring greater accountability regarding who is accessing Medicare eligibility information on behalf of providers.
Many chiropractors mistakenly believe the requirement applies only to clearinghouses. However, CMS specifically requires provider enrollment and attestation tied to the provider’s NPI. Clearinghouses and vendors cannot simply complete the process independently without provider participation.
If HETS access is interrupted, offices may experience inability or delays in Medicare eligibility and confirming deductibles.
The changes, while important, affect eligibility verification rather than claims submission itself. The new CMS HETS requirements are primarily about accountability, cybersecurity and authorization of electronic Medicare eligibility access.
For chiropractors, the key issue is understanding that your NPI is being used to access Medicare eligibility data. CMS now wants direct provider authorization for that access, and providers can no longer assume vendors are handling everything automatically.
Chiropractic offices should proactively contact their clearinghouses, EHR vendors, billing services, ,and software companies to ensure all HETS enrollment and attestation requirements are completed. Failure to do so may result in Medicare eligibility transaction rejections and operational disruptions.
Editor’s Note: Have a billing question? Submit it via email to Sam at sam@hjrossnetwork.com. Your question may be the subject of a future column.
