HIPAA Eligibility Transaction System (HETS) Trading Partner Agreement (TPA)

CMS Real-Time Eligibility Agreement and MDCN Access Request

OMB: 0938-0960

IC ID: 8819

Information Collection (IC) Details

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HIPAA Eligibility Transaction System (HETS) Trading Partner Agreement (TPA)
 
No Modified
 
Required to Obtain or Retain Benefits
 
45 CFR 164.312(a)(2)(i)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-10157 Medicare HIPAA Eligibility Transaction System (HETS) to Conduct the Health Care Eligibility Benefit Inquiry and Response TPA_PRA_Form_Revision_ Final_V4.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

1,000 0
   
Private Sector Businesses or other for-profits
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 1,000 0 0 0 0 1,000
Annual IC Time Burden (Hours) 250 0 0 0 0 250
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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