CMS Issues Updated Section 111 User Guide

CMS issued an updated Section 111 NGHP User Guide this month. The new User Guide includes guidance that CMS recently issued confirming that indemnity only settlements are not reportable under Section 111. The User Guide also indicates that if indemnity and medicals are settled together, the total amount of the settlement should be reported regardless of how the funds are allocated.

The User Guide also includes the following technical updates:

• Certain error codes now will now longer cause a record to be rejected. Records with these error codes will be processed but RREs should correct the errors and resubmit the claim on their next quarterly file submission. The error codes include: CC05, CC11, CC12, CC13, CC25, CC31, CC32, CC33, CC45, CC51, CC52, CC53, CC65, CC71, CC72, CC73, CI02, CI03, CI25, CP06, CP07, CP08, CP09, CP10, CP13 (new), CR11, CR12, CR13, CR14, CR31, CR32, CR33, CR 34, CR51, CR52, CR53, CR54, CR71, CR72, CR73, CR 74, CR91, CR92, CR93, CR94, and TN30.

• Claim input file records and Direct Data Entry (DDE) records submitted prior to the claimant’s Medicare entitlement date will now be rejected and returned with the Disposition Code ‘03’ instead of an SP31 error.

• For no-fault claims, if the reported no-fault policy limit is less than $1,000.00, the record will be accepted but a CP13 error will be returned to notify RREs to confirm the dollar amount submitted. DDE submitters will see a message prompt on the Insurance Information page but will be able to submit the record.

• The descriptions of the No-Fault Insurance Limit field and the CP11 error code have been clarified to reflect that the No-Fault Insurance Limit field cannot be filled with all zeros for no-fault cases.

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. Please let us know if you have any questions about the new User Guide or any other Section 111 reporting issues.