CMS Releases MMSEA Section 111 NGHP User Guide Version 4.4

CMS, Medicare Set-Aside Blog, MSP News on January 7, 2015 | Posted by Jessica M. Wingenroth, JD

CMS released an updated NGHP User Guide, Version 4.4, dated January 5, 2015. The primary changes include:

  1. The TPOC Liability Claim Report Rejection code CJO7 changed in definition so that cumulative liability TPOC reports of amounts less than or equal to $1,000, with no ORM, will be rejected. The prior NGHP User Guide had indicated that TPOCs from $300 to $1,000 may be reported, but that there was no requirement to do so, and that only liability TPOCs of less than $300 would be rejected.
  2. The User Guide was updated to incorporate the SMART Act mandated change to allow for submission of partial, 5-digit Social Security Numbers on claim and query input files as well as via Direct Data Entry. Changes include the addition of disposition code DP (duplicate) to Table F-1. Disposition code DP will be returned if after using the partial, 5-digit SSN, along with other matching criteria, multiple matching beneficiaries are returned.

Updates were also made to: disposition code 51 in Table F-1; Fields 3 and 4 in Table B-2; Error Code TN99 in Table F-4; and Table C-2. Error Code CB05 has been removed from the Claim Response File Error Code Resolution Table.