CMS Releases Updated NGHP User Guide Version 4.3

CMS has released an updated User Guide for NGHPs, version 4.3, on October 6, 2014.

While the updates contained in the new version appear to be minor, Helios 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:


  • CR12120: When implemented, RREs will not be allowed to report ICD-10 “Z” codes. These are now excluded from Section 111 claim reports(Chapters IV & V).
  • CR 12178: Missing excluded ICD-10 codes added to Appendix J, Chapter V.
  • CR 12373: Updated to reflect the delay of ICD-10 diagnosis code implementation from October 2014 to 2015 (Chapters IV & V).
  • CR 12590: For ICD-10 changes, field numbering/layout discrepancies were corrected in Table A-2 (Claim Input File  Supplementary Information), Chapter V.
  • CR 12170: Two threshold error checks for the Claim Input File were implemented in July 2011. These errors are related to the dollar values reported for both the cumulative TPOC amounts and the No-Fault Insurance Limit (Chapter IV).
  • CR 12593: Reviewed to ensure that spouse references are gender-neutral according to DOMA.
  • CR 12636: The Appendix L alerts table has been removed and replaced with links to the Section 111 web site, which posts all current alerts and stores all archived alerts (Chapter V).
  • CR 12829: Updated CS field numbers in Table F-4 (Claim Response File Error Code Resolution Table) to accommodate ICD-10 revisions(Chapter V).

Details of each noted change request are located in the first chapter of each section of the guide.

The updated chapters of the User Guide 4.3 can be found at the following address:

For more information, please contact Frank Fairchok, Senior Manager of MedicareConnect at

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