CMS Publishes Updated NGHP User Guide to Include Recent Alerts and the NGHP Town Hall Teleconference


7/13/2015

On Monday, July 13th, 2015 the Centers for Medicare and Medicaid Services (CMS) published version 4.7 of the MMSEA Section 111 Non-Group Health Program (NGHP) User Guide, found here.

The changes were minimal and did not add new information. Rather, the changes simply incorporated recent Alerts. Below is a summary of the changes:

  • Previously, CMS used a workaround to allow the RREs to submit TPA information on the TIN Reference File. This work around has been eliminated, and a permanent solution will allow RREs to submit recovery agent name and contact information in the newly dedicated fields.
  • Table B-2, TIN Reference File Detail Record, has been altered to add fields for submission of recovery agent information (fields 3 and 5-11 updated, field 16 redefined, fields 17-23 added)
  • Table D-2, TIN Reference Response File Detail Record, (field 34 redefined, new fields 34-48 added)
  • Table F-5, TIN Reference Response Error Code Resolution Table, added the new error codes TN24-TN36 for recovery agent information submissions.
  • The term "third-party administrators or their agents" has been replaced with "recovery agent".
  • The URL for accessing the Section 111 Coordination of Benefits Secure Website (COBSW) has been changed to: https://www.cob.cms.hhs.gov/Section111/
  • The submission of Partial SSN of five digits caused excessive numbers of false positive matches results. To prevent this, the matching criteria have been changed as follows: when an exact match on the partial SSN is found, then four out of the four remaining data elements (legal first name, legal last name, date of birth and gender) must be matched exactly. The matching criteria for HICNs and full SSNs are unchanged.
  • The Response file naming convention was changed for NGHP files submitted by SFTP and HTTPS. (Chapter IV Sections 10.3 and 10.4) Dropped the centiseconds and added the numbers 0000 to 9999.
    Claim Response: PCOB.BA.MR.NGHPCLM.RESP.Dccyymmdd.Thhmm####.TXT
    • Where 'Dccyymmdd' is 'D' followed by a date as century/year/month/day and 'Thhmm####" is 'T' followed by a time as hours/minutes and a number from 0000 to 9999.
    TIN Response:
    PCOB.BA.MR.NGHPTIN.RESP.Dccyymmdd.Thhmm####.TXT
    • Where 'Dccyymmdd' is 'D' followed by a date as century/year/month/day and 'Thhmm####" is 'T' followed by a time as hours/minutes and a number from 0000 to 9999.
    Query Response:
    PCOB.BA.MR.NGHPQRY.RESP.Dccyymmdd.Thhmm####.TXT
    • Where 'Dccyymmdd' is 'D' followed by a date as century/year/month/day and 'Thhmm####" is 'T' followed by a time as hours/minutes and a number from 0000 to 9999.

CMS will be hosting a NGHP Policy and Technical Support related teleconference event. Opening remarks will be made along with a presentation by CMS, followed by a question and answer session with the audience. Questions can be submitted prior to the teleconference by using the link below.

Following opening comments from CMS regarding the upcoming transition of a portion of the Non-Group Health Plan Recovery Workload to the Commercial Repayment Center, the call will address both policy and technical questions regarding Section 111 reporting.

CMS staff and representatives of both the BCRC Contact Center and the BCRC EDI Department will be available throughout the call.

Date: July 28, 2015 Call-in

Time: 1:00 PM - 2:00 PM Eastern time. Participation is by telephone only. Call-in Line: (800) 603-1774

Pass Code: Section 111 Please begin dialing in approximately 20 minutes before the call start time, due to the large number of participants.

Questions for the Call: Please submit questions as soon as possible to: PL110-173SEC111-comments@cms.hhs.gov

ExamWorks Clinical Solutions will participate in the teleconference and provide a summary and analysis of relevant information. Should you have any questions regarding the updated NGHP User Guide v4.7 or questions about the Town Hall Teleconference, please do not hesitate to directly contact your MMSEA Compliance Manager, or our Reporting Services Department at MIRService.Support@examworks-cs.com or 866.672.3453 x 1122.

Sincerely,

ExamWorks Clinical Solutions

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