CMS Releases Updated NGHP User Guide Version 4.6

CMS released an updated User Guide for NGHPs, version 4.6, on April 6, 2015.

The update contained in the new version appears to have been previously released on a technical alert dated November 25, 2014 regarding the use of partial Social Security Numbers for NGHP Section 111 reporting. 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 change noted in the revision history of the document lists the following items:

CR13592: In instances where a duplicate is returned, indicated by the disposition code “DP” or messaging on the Beneficiary Not Found page, users are instructed on what actions to take to remain in compliance with reporting requirements (Chapters IV & V). See Chapter 1 for details.

This change request relates to a scenario where a DP disposition code is returned by CMS when a 5-digit SSN is used to query beneficiary status, but cannot be matched to a single record. The resolution, as detailed in the User Guide 4.6 and the original alert, includes validating all the query related fields, submitting the full 9-digit SSN (if available) and then contacting the BCRC at 1-855-798-2627 if a distinct match can still not be made.

The updated chapters of the User Guide 4.6 can be found here.

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 4.6, please contact Helios at JustRegister@Helioscomp.com.

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