Novitasphere displays once-in-a-lifetime preventative benefits in the Eligibility feature. If the patient has not yet had one of the once-in-a-lifetime codes, the procedure code will display with the “Next Technical Date” and “Next Professional Date” dates populated. These dates will indicate the next time the patient is eligible for the service. This date may even be a past date if the patient has already been eligible for that service for some time.


Novitasphere has been carefully designed with various accessibility options to allow use by all individuals. These options include the abilities like changing the font size without sacrificing usability, navigating the application using just a keyboard. With the use of assistive software such as JAWS listening to most of the website, and the user guide using a screen reader (with the use of assistive software such as JAWS)

The Novitasphere Eligibility Criteria

Novitasphere interfaces with the CMS HIPAA Eligibility Transaction System (HETS) to obtain eligibility information. HETS is considered the authoritative source for beneficiary information. Per CMS, “The HIPAA. Eligibility Transaction System (HETS) is intended to allow the release of eligibility data to Medicare providers or their authorized billing agents for the purpose of preparing an accurate Medicare claim, determining beneficiary liability, or determining eligibility for specific services.”


More information about HETS can be found at https://www.cms.gov/Research-Statistics-Data-and-Systems/CMS-InformationTechnology/HETSHelp/index.html. Medicare Diabetes Prevention Program (MDPP) providers enrolled with specialty D1: Effective with the April 16, 2018 release, the modified MDPP supplier Eligibility response will return only the following information (as applicable for the Medicare Beneficiary):

  • Medicare Beneficiary Demographics
  • Date of Death
  • Unlawful Occurrences
  • Medicare Part B Entitlement
  • MDPP Coverage
  • ESRD – Medicare Beneficiaries in an active ESRD occurrence are not MDPP eligible.
  • Medicare Advantage (MA) Enrollment(s) – Contact the MA plan for MDPP Coverage Information.
  • Medicare as a Secondary Payer (MSP) Enrollment(s)