Medicare and federal transaction rules continue to change how practices verify eligibility, identify beneficiaries, work with vendors, and exchange claims-related documentation. Some of these changes are new as of 2026. Others are important reminders that still trip up offices.
Impact: If your workflows are not current, eligibility checks can fail, documentation can be delayed, and payment problems can follow. The goal is simple: know what has changed before it becomes a front-desk or billing problem.
What’s Changed?
- New HETS EDI enrollment requirements for original Medicare eligibility verification.
- MBI workflows: not new, but still important.
- New national standards for electronic health care claims attachments.
- Electronic-signature standards tied to claims attachment transactions.
1. HETS: New EDI Enrollment Requirements
HETS, the HIPAA Eligibility Transaction System, is used for electronic original Medicare fee-for-service eligibility verification. It is not the eligibility system for Medicare Advantage or Part D plans.
As of May 11, 2026, CMS requires an active HETS EDI enrollment for each NPI submitted by a vendor or clearinghouse through HETS. Without a current, valid enrollment relationship, HETS rejects the eligibility request.
Why it matters: If verification fails, your office can lose real-time visibility into Original Medicare eligibility. That can create confusion at check-in, billing delays and extra staff time.
What you should do: If your office relies on a clearinghouse, billing company, eligibility vendor, or software platform, confirm that your NPI is properly enrolled and linked.
Questions to ask your vendor or clearinghouse:
- Do you use HETS for our Original Medicare eligibility checks?
- Which NPI or NPIs are submitted through HETS on our behalf?
- Is each NPI actively enrolled for HETS EDI access?
- Is our NPI properly linked to your HETS Submitter ID / vendor relationship?
- If an eligibility request is rejected, what error will we see and who is responsible for fixing it?
2. MBIs, Not SSN-Based Medicare Numbers
Medicare beneficiary identifiers (MBIs) are not a new 2026 requirement. CMS replaced SSN-based health insurance claim numbers on Medicare cards years ago and now uses MBIs for Medicare transactions such as billing, eligibility and claim status.
But do not turn that into an absolute rule that your office can never request a Social Security number. CMS’s own MBI lookup process may require the patient’s SSN along with name and date of birth.
What you should do: Use the MBI for Medicare transactions that require the beneficiary identifier. Do not routinely collect or disclose SSNs without a specific, legitimate purpose and appropriate safeguards. Make sure your staff understands the difference between the MBI used for Medicare transactions and an SSN that may be needed for a limited lookup or other lawful purpose.
3. Claims Attachments and Electronic Signatures
Another important 2026 development is not limited to Medicare. HHS finalized national HIPAA Administrative Simplification standards for electronic health care claims attachments and related electronic signatures.
The final rule became effective May 26, 2026, with a compliance date of May 26, 2028. For covered entities conducting these claims-attachment transactions electronically, the new standards will apply.
The rule establishes national standards for electronically exchanging claims-related supporting documentation, helping reduce the industry’s reliance on manual processes such as faxing and mailing.
What you should do: Do not wait until 2028 to discover that your EHR, billing software, clearinghouse or workflow is not ready. Ask yourself now:
- Will our EHR support the new claims attachment standards?
- Will our billing software and clearinghouse support the required X12N 277/275 transactions and applicable clinical-document standards?
- How will the requested documentation be formatted, signed and transmitted?
- What changes will staff need to make before the May 26, 2028 compliance date?
Compliance Is Not Scary ... If You Are Prepared
Small chiropractic offices do not need to become Medicare transaction experts. But doctors do need to know enough to ask the right questions, require the right documentation, and make sure the people and companies handling their billing are ready.
Get current. Get documented. Ask your vendors now. And if you are not sure whether your workflows meet the requirements, get qualified help before confusion becomes a payment problem.
Source Notes
- HETS EDI: How to Enroll. Centers for Medicare & Medicaid Services (CMS). Read Here
- Medicare HETS 270/271 - HETS EDI Enrollment Validation - 5/11/26. Centers for Medicare & Medicaid Services. Read Here
- Medicare Beneficiary Identifiers (MBIs). Centers for Medicare & Medicaid Services. Read Here
- Getting MBIs. Centers for Medicare & Medicaid Services. Read Here
- “Administrative Simplification; Adoption of Standards for Health Care Claims Attachments Transactions and Electronic Signatures.” Federal Register, Mar. 24, 2026. Read Here
