CMS Real-time Eligibility Agreement and Access Request

Type of Information Collection Request: Revision of a currently approved collection; Title of Information Collection: CMS Real-time Eligibility Agreement and Access Request; Form Number: CMS-10157 (OMB: 0938-0960); Use: 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 conduct the eligibility transaction on a real-time basis to access Medicare beneficiary information provide certain assurances as a condition of receiving access to the Medicare database for the purpose of conducting eligibility verification. Health care providers, clearinghouses, and health plans that wish access to the Medicare database are required to complete this form. The information will be used to assure that those entities that access the Medicare database are aware of applicable provisions and penalties. Frequency: Recordkeeping and Reporting--One time; Affected Public: Business or other for-profit, Not-for-profit institutions; Number of Respondents: 2000; Total Annual Responses: 500; Total Annual Hours: 500. (For policy questions regarding this collection contact Vivian Rogers at 410-786- 8142. For all other issues call 410-786-1326.)