Section 111 NGHP User Guide Version 4.3, Revised to Implement Eight Change Requests, Primarily Related to ICD-10 Coding

Medicare Set-Aside Blog, MSP News on October 9, 2014
Posted by Jessica M. Wingenroth, JD

According to the Revision History, Version 4.3 of the NGHP User Guide applies more changes than any other update in the 5+ years since Version 1.0 was published.  A majority of the changes are associated with ICD-10 coding, which will be required when RREs are reporting dates of incidents occurring as of 10/01/15.

ICD-10-related revisions to the User Guide include:

  1. RREs will not be permitted to report ICD-10 codes beginning with a “Z.” Z-codes represent encounters for routine health checks and do not identify a specific diagnosis.
  2. Excluded ICD-10 codes were added to Appendix J.
  3. Clarification that ICD-10 reporting was delayed from October 2014 to October 2015.
  4. ICD-10 field and layout corrections were made in Table A-2.
  5. Fields were updated in Table F-4 for ICD-10.

The remaining three changes are as follows:

  1. The threshold error for cumulative TPOC amounts and No-Fault Insurance Limits changed to trigger an error for an amount reported over $100,000,000.00. One exception is for the No-Fault Insurance Limit Field 81, which will continue to accept a default value of $999,999,999.99.
  2. The User Guide was reviewed to ensure that all spouse references are gender-neutral in accordance with The Department of Health & Human Services policy.
  3. The Appendix L alerts table was eliminated and replaced by links to Alerts published on the NGHP Section 111 web site.

MMSEA Section 111 NGHP User Guide Version 4.3 can be found at:  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