On April 5, 2011, the Centers for Medicare & Medicaid Services (CMS) issued an alert providing information pertaining to the upgrade of Query Files and HIPPA Eligibility Wrapper (HEW) Software to ASC X12 270/271 Version 5010A1 under Section 111 of the Medicare, Medicaid and SCHIP Extension Act (MMSEA). The alert addressed the implementation and scheduled upgrade to the Eligibility Inquiry/Response set used for Section 111 Query Files and the HEW translation software.
This upgrade affects all Section 111 query files exchanged with the CMS Coordination of Benefits Contractor (COBC). Differences between Versions 4010A1 and 5010A1 are minor and adoption of Version 5010A1 should not be difficult. The upgrade to the new version of HEW software (Version 3.0.0) should be completed by January 1, 2012 by all Responsible Reporting Entities (RREs) using the current HEW software. Testing of the new version is recommended but not required.
For RREs using their own X12 translator software, CMS will publish updated Section 111 X12 270/271 companion guides by July 1, 2011. A copy of the new PC/server Version 3.0.0 HEW software will be available for download on the Section 111 COB Secure Website (COBSW) on October 1, 2011 at www.section111.cms.hhs.gov. RREs may also request a copy of the new software from their assigned EDI Representative as of October 1, 2011.
Layouts for the flat file input and output for HEW Version 3.0.0 will be similar to those used for HEW Version 2.0.0. HEW Versions 1.2.0 and 2.0.0 will be discontinued as of January 1, 2012 and may no longer be used as of that date by Section 111 RREs.
- Test and production query files may continue to be submitted using Version 4010A1 (and HEW Versions 1.2.0 and 2.0.0) through December 31, 2011.
- Version 4010A1 query files (or query files created using HEW Versions 1.2.0 and 2.0.0) submitted and accepted by December 31, 2011, but processed on or after January 1, 2012, will be returned using Version 4010A1.
- Query files submitted on or after January 1, 2012 under Version 4010A1 (or created using HEW Versions 1.2.0 and 2.0.0) will be rejected with a severe error and not processed.
- Test and production query files may be submitted using Version 5010A1 (and HEW Version 3.0.0) as of October 1, 2011.
Click Here to review the CMS Alert in its entirety.