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CMS Publishes Updated NGHP User Guide to Include Recent Alerts

Tuesday, January 13, 2015

On Tuesday, January 6, 2015 the Centers for Medicare and Medicaid Services (CMS) published version 4.4 of the MMSEA Section 111 Non-Group Health Program (NGHP) User Guide.

The changes were minimal and do not include new information. Rather, the changes simply incorporate recent Alerts. Below is a summary of the changes:

  • Updated to reflect the lower limit threshold change from $300 to $1,000 for TPOC liability reporting. Liability insurance (including selfinsurance) claim reports with no ongoing responsibility for medicals (ORM) and cumulative TPOC amounts less than or equal to $1,000 will reject with a CJ07 error if the most recent TPOC date is October 1, 2014 or after (Chapters III and IV).
  • Updated to reflect reporting change based on requirements of the SMART Act. Responsible Reporting Entities (RREs) can now submit records with either a partial 5-digit Social Security Number (SSN) or a full 9-digit SSN (Chapters I, II, IV and V).
  • Updated Table B-2 (Fields 3 and 4) and Table F-4 (Error Code TN99) with the appropriate field number references (Chapter V).
  • Because of updates to Disposition Code 51, updated description information in Table C-2 for applied fields (Fields 16, 18, 19, 20, 21 and 22) (Chapter V).

Should you have any questions regarding the updated NGHP User Guide v4.4, please do not hesitate to directly contact your MMSEA Compliance Manager, or our Reporting Services Department at MIRService.Support@examworkscs.com or 866.672.3453 x 1122.

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