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.