NGHP MMSEA Section 111 User Guide Version 6.1 Released

CMS, Mandatory Insurer Reporting on November 19, 2020
Posted by Shannon Flynn

Recently, the Centers for Medicare & Medicaid Services (CMS) released Version 6.1 of their NGHP MMSEA Section 111 User Guide as well as a corresponding Technical Alert, which highlights the functional impact of these changes.

CMS explained that effective April 5, 2021, thirty-seven (37) existing error codes will no longer result in the rejection of a Claim Input File, but rather, will be accepted with the requirement that the Responsible Reporting Entity (RRE) correct the error on their next quarterly file submission. Version 6.1 updates included this introduction of “soft” errors, as well as changes to disposition and error codes. More detailed information on these changes is provided below.

Chapter IV – Summary of Version 6.1 Updates (1-1)
Starting April 5, 2021, the following change will become effective: Claim Input File Detail Records, and Direct Data Entry (DDE) records, submitted prior to the effective date of the injured party’s entitlement to Medicare will be rejected and returned with a Disposition Code ‘03’ instead of an SP31 error (Section 7.2).

Chapter V – Summary of Version 6.1 Updates (1-1)
Starting April 5, 2021, the following changes will become effective:

  • Several Section 111 input record errors that would cause a record to reject will become “soft” errors; that is, they will no longer cause the input records to be rejected. RREs, however, will continue to receive the errors on their response files, and they should correct and resubmit on their next quarterly file submission. The errors include: CC05, CC11, CC12, CC13, CC25, CC31, CC32, CC33, CC45, CC51, CC52, CC53, CC65, CC71, CC72, CC73, CI02, CI03, CI25, CP03, CP06, CP07, CP08, CP09, CP10, CP13 (new), CR11, CR12, CR13, CR14, CR31, CR32, CR33, CR 34, CR51, CR52, CR53, CR54, CR71, CR72, CR73, CR 74, CR91, CR92, CR93, CR94, and TN30 (Appendix F).
  • A new “soft” edit will be added and applied to NGHP Claim Input File Detail Record files when users submit a no-fault insurance claim where the policy limit is less than $1000.00. The input files will be accepted but a new CP13 error will be returned on the response files. Direct Data Entry (DDE) submitters will see a message on the Insurance Information page but will be able to proceed with data entry without correcting (Appendix F).
  • Claim Input File Detail Records, and Direct Data Entry (DDE) records, submitted prior to the effective date of the injured party’s entitlement to Medicare will be rejected and returned with a Disposition Code ‘03’ instead of an SP31 error.

Chapter V – Appendix F (F-4)

CC, CI, CP, CR, and TN errors are as follows:

Chapter V – Appendix F (F-40)

New Error Code CP13:

Error Code – CP13
Record – Claim Input File Detail Record No Fault Insurance Limit (Field 61)

Field Required – Yes if Plan Insurance Type (Field 51) = D

Record Layout Field Description – Dollar amount of limit on no-fault insurance. Specify dollars and cents with implied decimal. No formatting (no $ or , or .) For example, a limit of $10,500.00 should be coded as 00001050000. Note: the last two positions reflect cents. For example, an amount of 500 dollars and no cents must be submitted as “00000050000.”

Possible Cause – Field 61: Dollar amount of No-Fault Insurance Limit (Field 61) is less than $1000.00. Error will not cause record rejection, but the error code will continue to appear on the response file. Correct and resubmit on your next quarterly file submission. (Effective April 5, 2021)

You can download Version 6.1 of the NGHP MMSEA Section 111 User Guide here.