CMS Issues Section 111 Alert and Updated User Guide

Last week CMS issued an Alert and updated User Guide for Section 111 reporting. The Alert provides that as of April 5, 2021, claim records will no longer be rejected for certain error codes. Although claim records will be processed, RREs will be responsible for correcting the errors in their next quarterly file submission. The error codes that will no longer result in claim record rejections are as follows: CC05, CC11, CC12, CC13, CC31, CC33, CC45, CC51, CC53, CC65, CC71, CC73, CI02, CI03, CI25, CP03, CP06, CP07, CP08, CP09, CP10, CR11, CR12, CR13, CR31, CR32, CR33, CR51, CR52, CR53, CR71, CR72, CR73, CR91, CR92, CR93, and CR94. In addition, when a no-fault insurance limit of less than $1,000.00 is submitted, the record will be accepted but a new error code of CP13 will be returned.

The updated User Guide incorporates the changes addressed in the Alert. The User Guide also clarifies that if a no-fault insurance policy limit of less than $1,000.00 is entered, Direct Data Entry submitters will see a message on the insurance information page but will be able to submit the claim record without changing the policy limit. Additionally, the User Guide also states that beginning April 5, 2021, claim input file records and Direct Data Entry records submitted prior to the beneficiary’s Medicare entitlement date will be rejected and returned with the Disposition Code ‘03’ instead of an SP31 error.

The Alert is available at https://www.cms.gov/files/document/technical-alert-revisions-section-111-edits-no-longer-cause-record-reject.pdf and the User Guide is available at https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Mandatory-Insurer-Reporting-For-Non-Group-Health-Plans/NGHP-User-Guide/NGHP-User-Guide. If you have any questions about the changes discussed in the Alert and User Guide, please let us know. We will be happy to help.