The HIPAA Eligibility Transaction System (HETS) is a suite of applications that streamlines Medicare claims processing by quickly responding to authorized requests for beneficiary liability and eligibility information in a secure way that protects the privacy of beneficiaries. The system provides Medicare beneficiary eligibility information in a real-time environment. The primary users of these systems are:

• Institutions servicing beneficiaries in the Medicare Part A program,
• Individuals and institutions and organizations servicing beneficiaries in the Medicare Part B program,
• Third party entities acting on behalf of Fee For Service providers, including billing agents, network service vendors and EDI clearing houses, and
• Medicare Administrative Contractors.

TurningPoint is providing professional requirements engineering (including elicitation, development, documentation, and management of requirements) to enhance the system to provide heightened HETS visibility, robust monitoring capabilities, and geographic diversity. The enhancements will enable HETS the high availability to support the projected growth of the Medicare beneficiary network over the coming years.

“This system is critical for ensuring that eligible beneficiaries receive the services they need,” said Michael Edwards, Vice President of Federal Delivery. “Our ability to deliver accurate and timely requirements engineering products will be paramount in supporting HETS system enhancements.”