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

The HIPAA Eligibility Transaction System (HETS) (CMS-10157)

OMB: 0938-0960

IC ID: 8819

Information Collection (IC) Details

View Information Collection (IC)

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_V4.1_BESST_HETS_2021-10-21-fillable.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

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

  Requested 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

Title Document Date Uploaded
No associated records found
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

© 2024 OMB.report | Privacy Policy