On May 17, 2011, the Centers for Medicare & Medicaid Services (CMS) issued a revised alert providing information pertaining to Non-Group Health Plans (NGHP), classified as Responsible Reporting Entities (RREs) under Section 111 of the Medicare, Medicaid and SCHIP Extension Act (MMSEA).
The revised alert provided RREs the following additional information regarding revisions being made to validation of tax identification numbers (TINs) and related name and address information effective October 1, 2011.
- The description for TIN error code TN01 was updated to note that the value submitted in the TIN (Field 3) of the TIN Reference File Detail Record cannot be blank or all spaces.
- The description for TIN error code TN06 was updated to note that the TIN/Office Code City (Field 8) of the TIN Reference File Detail Record cannot contain any numeric characters.
- The description for TIN error code TN03 was updated to note that the first two characters of the TIN/Office Code Mailing Name (Field 5) of the TIN Reference File Detail Record must be non-blank.
- The description for Section 111 Reporting File Type (Field 3) of the TIN Reference Response File Header Record was corrected to state that a value of ‘NGHTNRP’ is returned in this field.
- The descriptions for Fields 13–17 on the TIN Reference Response File Detail Record were corrected.
- The system will generate the standard email notification to the RRE’s Account Manager when the TIN Reference Response File has been created.
- RREs are encouraged to pre-validate RRE addresses using postal software or online tools available on the United States Postal Service (USPS) website pages such as http://zip4.usps.com/zip4/welcome.jsp. In general, USPS standards limit name and address lines to 40 characters with 8 separate words per line. Even though the TIN/Office Code Name and Address Lines 1 and 2 on the TIN Reference File Detail Record are longer, RREs should try to use standard abbreviations and attempt to limit data submitted in these fields to the first 40 characters. The address validation enhancements effective in the COBC Section 111 system in October 2011 will “scrub” addresses submitted on the TIN Reference File using USPS standards but it is recommended that RREs attempt to adhere to these standards as well to improve results.
- No new Claim Input or TIN Reference Files will be processed by the COBC during September 22-30, 2011 in order to allow the system to complete TIN-related processing under current requirements. If an RRE submits these files during this week, they will be held and processed after the release implementation under the new address validation rules. RREs assigned to Claim Input File submission timeframe Group 12 (submission dates of September 22-28, 2011) are to submit Third Quarter 2011 files prior to this week to process under the current rules or submit their files the week after October 1, 2011 to process under the revised rules. CMS will not consider Third Quarter 2011 Claim Input Files for RREs assigned to Group 12 late if they are submitted by October 7, 2011.
RREs may receive the TIN and TIN address compliance flags on Third Quarter 2011 Claim Response Files returned after October 1, 2011 if the corresponding Claim Input File was submitted prior to September 22, 2011.
To review the Alert in its entirety click here.