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April 18, 2019

July 2019 Changes to Common Working File (CWF) Eligibility Systems ELGA, ELGH, HIQA and HIQH

Effective July 1, 2019, ELGA, ELGH, HIQA and HIQH will display a message before beneficiary eligibility information is made available.  This message will notify you that beginning in the fall of 2019, the Centers for Medicare & Medicaid Services (CMS) plans to terminate access to ELGA, ELGH, HIQA and HIQH for those who already use the HIPAA Eligibility Transaction System (HETS)This will affect clearinghouses, third-party billers, providers and other users.

In December 2012, CMS announced plans to discontinue the CWF beneficiary health insurance eligibility transactions (MLN Matters® Special Edition Article SE1249External PDF).  These transactions include the eligibility systems ELGA, ELGH, HIQA, and HIQH.  In that same article, CMS also announced the HIPAA Eligibility Transaction System (HETS) would be the single source for this data.

What Providers Need to Know
Effective July 1, 2019, once you enter the required information to access beneficiary eligibility in ELGA, ELGH, HIQA and HIQH, a new screen will display the new message.  You will need to press the “ENTER” key to acknowledge the message before eligibility information displays.  If you use screen-scraping and/or other automation methods to obtain beneficiary eligibility information via ELGA, ELGH, HIQA and HIQH, you may need to modify your program in order to accept the message.  

If you currently use both the CWF eligibility transactions and HETS to obtain Medicare beneficiary eligibility information, it is recommended that you begin using HETS exclusively.  For additional information about HETS, refer to the HIPPA Eligibility Transaction System (HETS)External Website Web page on the CMS website.  CGS also recommends contacting your clearinghouse/vendor to notify them of this change, and ask if they offer the HETS application.

As a reminder, you can access Medicare beneficiary eligibility information by using myCGS, the free CGS website portal.  Learn more about what myCGS offers by accessing the following resources.

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