Updated MMSEA Section 111 NGHP User Guide Issued

Uncategorized on July 1, 2020
Posted by Jean S. Goldstein, JD, CMSP



An updated MMSEA Section 111 NGHP User Guide version 5.9 has been posted to the NGHP User Guide page on CMS.gov with minor updates. Each chapter section has a summary of updates. For convenience the updates are listed below:

Updates to the Policy Guidance Chapter Version 5.9 of the NGHP User Guide.

• A reminder has been added that while the threshold for physical trauma-based liability insurance settlements remains at $750, this threshold does not apply to non-trauma liability reporting for alleged ingestion, implantation, or exposure cases. Any settlement, regardless of amount, should be reported for these types of cases. (Sections 6.4.2, 6.4.3, and 6.4.4).

Updates to the Technical Information Chapter Version 5.9 of the NGHP User Guide.

• A reminder has been added that while the threshold for physical trauma-based liability insurance settlements remains at $750, this threshold does not apply to non-trauma liability reporting for alleged ingestion, implantation, or exposure cases. Any settlement, regardless of amount, should be reported for these types of cases. (Sections 6.4.2, 6.4.3, and 6.4.4).

• The limit dollar amount that triggers a threshold error has been adjusted from $99,999,999 to $99,999,999.99. This error occurs any time the No-Fault Insurance Limit amount or the cumulative value of all reported TPOCs (detailed and auxiliary records) exceed this limit. Additionally, the No-Fault Insurance Limit field number has been corrected under “Exceptions.” (Section 7.3.2).

• When considering the requirements for the Ongoing Responsibility for Medicals (ORM), remember, per current policy, that the dollar limit for No-Fault Insurance Limits (Field 61) represents a combined total of Med-Pay and Personal Injury Protection (PIP) (Section 6.7.1).

Updates to the Appendices Chapter Version 5.9 of the NGHP User Guide.

• When considering the requirements for the Ongoing Responsibility for Medicals (ORM), remember, per current policy, that the dollar limit for No-Fault Insurance Limits (Field 61) represents a combined total of Med-Pay and Personal Injury Protection (PIP) (Appendix A).

• Several no-fault excluded ICD-10 codes have been removed from the Excluded ICD-10 and ICD-9 Diagnosis Codes table ( and can be found in Appendix I).

• The CR02 claim response file error code field number has been corrected (Appendix F) (Table F-4)

For questions regarding this user guide, please reach out to our team at info@medval.com.