CMS Releases Updated NGHP User Guide Version 4.0

CMS has released an updated User Guide for NGHPs. Although the User Guide is dated October 7, 2013, it was not released to the public until October 18, 2013. Access to the updated User Guide can be found here.

User Guide 4.0 incorporates changes announced via alerts over the past several months in relation to the conversion to ICD-10 coding with respect to MMSEA Section 111 Mandatory Insurer Reporting.

PMSI encourages RREs and claim administrators to review the new User Guide in its entirety to ensure compliance.  However, we have noted the following as a summary of the more significant updates included in the new User Guide:

  • Inclusion of three June 2013 alerts regarding transition to ICD-10, testing for
    ICD-10 codes, and new ICD-9/10 excluded codes.
  • Layout changes to the claim input file detail record include repurposing of the ICD-9 fields to accommodate ICD-10 code lengths by adding spaces that were reserved for future use in previous editions of the Guide.  A new ICD indicator has also been added from reserved space and will be used to indicate which coding has been utilized within the claim.
  • Inclusion of updated hyperlinks on Medicare and COBC web pages where outdated hyperlinks existed.
  • Disposition code 50 has been clarified; CMS indicates that RREs should only expect to receive a low volume of responses with this code.
  • Computer Based Training (CBT) Modules: Users no longer need to register for CBTs and the modules can be accessed directly from the CMS website.

In addition to the updated User Guide, CMS issued a revision to the August 14, 2013 alert regarding diagnosis codes that are no longer valid for reporting as of January 6, 2014. This revision adds ICD-10 cluster codes related to diabetes to the list of invalid codes. A copy of the revised alert can be obtained here (CMS has indicated changes with a bold font for ease of reference).

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