CMS Releases Updated NGHP User Guide Version 4.1

Frank FairchokCMS has released an updated User Guide for NGHPs. Although the User Guide is dated February 3, 2013, it was not posted to the “NGHP User Guide” page until February 11, 2014.

While the updates contained in the new version appear to be minor, PMSI encourages RREs and claim administrators to review the new User Guide in its entirety to ensure compliance. The changes are noted in the revision history of the document as the following items:

CMS updated the User Guide to include ICD diagnosis codes no longer allowed for use on no-fault claim records. Changes to the guide include the following areas:

  • Chapter 4 – section 6.2.5 has been modified to contain wording that certain ICD-9 and ICD-10 codes are no longer valid for plan type D, or no-fault insurance claims.
  • Chapter 5 – Appendix J has been added to list out the ICD-9 and ICD-10 codes no longer valid for no-fault insurance claims.

The User Guide has undergone branding changes related to the new Benefits Coordination & Recovery Center (BCRC). This restructuring from the COBC and MSPRC was announced as completed on the “What’s New” page as of February 5, 2014.

The updated chapters of the User Guide 4.1 can be found at the following address: http://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Mandatory-Insurer-Reporting-For-Non-Group-Health-Plans/NGHP-User-Guide/NGHP-User-Guide.html

For more information, please contact Frank Fairchok, Senior Manager of MedicareConnect at Frank.Fairchok@pmsisettlement.com.

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