CMS Real-Time Eligibility Agreement and MDCN Access Request

ICR 201702-0938-002

OMB: 0938-0960

Federal Form Document

IC Document Collections
ICR Details
0938-0960 201702-0938-002
Historical Active 201608-0938-008
HHS/CMS CMS-10157
CMS Real-Time Eligibility Agreement and MDCN Access Request
Extension without change of a currently approved collection   No
Regular
Approved without change 03/03/2017
Retrieve Notice of Action (NOA) 02/15/2017
  Inventory as of this Action Requested Previously Approved
03/31/2020 36 Months From Approved 05/31/2017
1,000 0 1,000
250 0 250
0 0 0

The Centers for Medicare and Medicaid Services (CMS) is requesting the Office of Management and Budget's (OMB) approval of a revised HIPAA Eligibility Transaction System (HETS) Trading Partner Agreement form. CMS created the HETS application to provide Health Insurance Portability and Accountability Act of 1996 (HIPAA) compliant 270/271 health care eligibility inquiries (270) and responses (271) on a real-time basis. In creating the HETS application, federal law requires that CMS take precautions to minimize the security risk to federal information systems. Accordingly, CMS is requiring that trading partners who wish to connect to the HETS 270/271 application via the CMS Extranet and/or Internet agree to specific trading partner terms as a condition of receiving access to Medicare eligibility information. Applicants will complete the entire Trading Partner Agreement form to indicate agreement with CMS trading partner terms and provide sufficient information to establish connectivity to the service and assure that those entities that access the Medicare eligibility information are aware of applicable provisions and penalties for the misuse of information.

US Code: 42 USC 241 Name of Law: PUBLIC HEALTH SERVICE
  
None

Not associated with rulemaking

  81 FR 30308 05/16/2016
81 FR 46925 07/19/2016
No

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 1,000 1,000 0 0 0 0
Annual Time Burden (Hours) 250 250 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$50,000
No
No
No
No
No
Uncollected
Kayla Williams 410 786-5887 [email protected]

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
02/15/2017


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