CMS Releases Updated NGHP User Guide Version 4.4

Insurance LawCMS has released an updated User Guide for NGHPs, version 4.4, on January 5, 2015.

The updates contained in the new version appear to have been previously released on alerts. While these edits are bringing the User Guide up-to-date with the alerts, 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:

  • CR 11817: Updated to reflect the lower limit threshold change from $300 to $1,000 for TPOC liability reporting. Liability insurance (including self-insurance) 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).
  • CR 11497: 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).
  • CR 13191: Updated Table B-2 (Fields 3 and 4) and Table F-4 (Error Code TN99) with the appropriate field number references (Chapter V).
  • CR 13263: 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).

Details of each noted change request are located in the first chapter of each section of the guide and in the referenced areas noted above.

The updated chapters of the User Guide 4.4 can be found at 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@helioscomp.com.

For a consolidated, single PDF file version of the User Guide 4.4, please contact Helios at JustRegister@Helioscomp.com.

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