New MMSEA Section 111 NGHP User Guide, Version 4.6, Released 04/06/2015

CMS, Medicare Set-Aside Blog on April 7, 2015
Posted by Jessica M. Wingenroth, JD

The newest installment of the NGHP User Guide incorporates data issued in CMS’ 11/25/14 Technical Alert regarding the reporting of partial SSNs. As you may recall, the Alert provided detailed instruction as to what action an RRE should take when Disposition Code “DP” (duplicate) is returned. Disposition Code “DP” is returned when there are multiple Medicare beneficiaries identified based upon the partial SSN and query data submitted. Under these circumstances, in order to remain in compliance an RRE is instructed to verify information and re-submit. The steps as written in the User Guide are:

  1. Verify that the SSN, name, gender, and date of birth were entered accurately and re-submit.
  2. Enter the full 9-digit SSN (if available) and re-submit.

If the system is still unable to locate a distinct match after re-submission, contact the BCRC at 1-855-798-2627. The RRE should provide the claim information to the customer service representative to file a self-report.

You can find these changes to Chapters IV and V in Version 4.6 of the User Guide here.