Tag Archives: RRE

CMS Educates the Public about ICD-10 through Instructional Videos; ICD-10 Set to go Live October 1, 2015

frankCMS has introduced two new videos on ICD-10. The videos can be found here. The videos are exceptional in explaining ICD-10 basic concepts and drives home why ICD-10 will help better communicate diagnoses in the healthcare industry than previously was available with ICD-9.

ICD-10 will not only be required by providers when billing for medical services, but additionally RREs will also have to utilize ICD-10 when reporting claims through MMSEA Section 111 to CMS. As a reminder, CMS last year issued a memorandum outlining the ICD-10 process for RREs which is set to begin October 1, 2015 (link can be found here).

Are you ready for ICD-10 implementation? MedicareConnect, our industry leading Mandatory Insurer Reporting (MIR) solution, is ahead of the curve for the October 1, 2015 ICD-10 implementation date and completely ready for the transition. Helios provides a free lookup tool which converts ICD-9 to ICD- 10 and can be found here (users can simply enter their e-mail address for access).

For more information on the ICD-10 transition or MedicareConnect, please contact Frank Fairchok, MedicareConnect Program Manager, at Frank.Fairchok@helioscomp.com.

CMS Releases Alert for Changes to Response File Naming Convention

CMS has released an alert dated October 27, 2014 detailing changes to the naming convention for claim, TIN and query response files that will take effect April 6, 2015. In order to ensure that filenames remain unique, CMS is modifying the time, or “T,” node of the filename convention. Instead of four digits representing seconds and centiseconds, a number from 0000 to 9999 will be inserted in the filename.

CMS had recently enabled this change in their production systems and it was detected by the Helios Section 111 reporting platform, MedicareConnect. After Helios brought the matter to CMS’s attention, and reminding them that the response file specification was published in the User Guide, CMS agreed to revert back to the previous coding and publish an alert to provide the normal six months of advance notice.

The full alert 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/Downloads/New-Downloads/Response-File-Naming-Convention-for-Liability-Insurance.pdf

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

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: 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.

CMS Issues NGHP Alert Clarifying MSP Criteria for Exposure, Ingestion, and Implantation Cases

On August 19th, CMS issued an NGHP alert which clarifies a previous alert regarding MSP applicability to exposure, ingestion, and implantation cases and the December 5, 1980 date. Within this alert, CMS notes that it is clarifying a previous alert dated October 11, 2011. For the new August 19th alert, click here. For the previous October 11, 2011 alert, click here.

The August 19th alert is very similar to the October 11, 2011 alert. The main change in the new alert is to reference that the “most recently amended operative complaint or comparable supplemental pleading” applies when looking to see if exposure, ingestion, or implantation was claimed or released before or after December 5, 1980.

In other words, RREs should take note that the most recently amended operative complaint or comparable supplemental pleading will be the document used in determining whether the exposure, ingestion, or implantation is claimed or released and whether the ingestion or exposure occurred on or after December 5, 1980 and thereby falls within the MSP or not.