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20/Nov/2025

On November 18, 2025, the Centers for Medicare & Medicaid Services (CMS) released the MMSEA Section 111 NGHP User Guide to version 8.2, revised on October 6, 2025. The latest version has been posted to the NGHP User Guide page, found here. The NGHP User Guide to version 8.2 replaces Version 8.1, which was released on May 5, 2025.

MMSEA III – November 18, 2025 – NGHP User Guide version 8.2 Summary of Version 8.2 Updates

Chapter 1: Introduction and Overview

The updates listed below have been made to the Introduction and Overview Chapter Version 8.2 of the NGHP User Guide. As indicated in prior Section 111 NGHP Town Hall teleconferences, the Centers for Medicare & Medicaid Services (CMS) continues to review reporting requirements and will post any applicable updates in the form of revisions to Alerts and the user guide as necessary. There are no changes for this version.

Chapter II: Registration Procedures

The update listed below has been made to the Registration Procedures Chapter Version 8.2 of the NGHP User Guide. As indicated in prior Section 111 NGHP Town Hall teleconferences, the Centers for Medicare & Medicaid Services (CMS) continues to review reporting requirements and will post any applicable updates in the form of revisions to Alerts and the user guide as necessary. There are no changes for this version.

Chapter III: Policy Guidance

The updates listed below have been made to the Policy Guidance Chapter Version 8.2 of the NGHP User Guide. As indicated in prior Section 111 NGHP Town Hall teleconferences, the Centers for Medicare & Medicaid Services (CMS) continues to review reporting requirements and will post any applicable updates in the form of revisions to Alerts and the user guide as necessary. Language has been updated to clarify different situations where it may be appropriate to submit multiple records for a single individual (Section 6.5.1.3).

 Chapter IV: Technical Information

The updates listed below have been made to the Technical Information Chapter Version 8.2 of the NGHP User Guide. As indicated on prior Section 111 NGHP Town Hall teleconferences, the Centers for Medicare & Medicaid Services (CMS) continues to review reporting requirements and will post any applicable updates in the form of revisions to Alerts and the user guide, as necessary. The number of days required to generate a response file for claim files has been corrected from 48 to 33 (Chapter 7). Starting April 2026, new reason codes will be available to further improve granularity and clarity of updates to MSP and drug coverage records. The new codes have been added to the Change Reason Description table with an asterisk (*) (Table 7-4).

Chapter V: Appendices

The updates listed below have been made to the Appendices Chapter Version 8.2 of the NGHP User Guide. As indicated on prior Section 111 NGHP Town Hall teleconferences, the Centers for Medicare & Medicaid Services (CMS) continue to review reporting requirements and will post any applicable updates in the form of revisions to Alerts and the user guide as necessary. The definitions of field 43 of the Claim Input File Detail Record table and CW09 of the Claim Response File Error Code Resolution table have been expanded for clarification (Appendix A and Appendix G). To ensure consistency of data the Recovery Agent TIN field is required if agent name is submitted (Appendix B and Appendix G).

270/271 Health Care Eligibility Benefit Inquiry and Response Companion Guide for Mandatory Reporting Non-GHP Entities Version 6.0

The email address for contacting an Electronic Data Interchange (EDI) Representative has changed to COBVA@bcrcgdit.com. However, COBVA emails coming from CMS now show the address as COBVA@mail.cms.hhs.gov (Customer Support).

For Additional Information

Medivest will continue to monitor changes occurring at CMS and will keep its readers up-to-date when such changes are announced. For questions, feel free to reach out to the Medivest representative in your area by clicking here or calling us directly at 877.725.2467.


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08/Apr/2025

On April 7, 2025, the Centers for Medicare & Medicaid Services (CMS) updated the MMSEA Section 111 NGHP User Guide to version 8.0. The newer version has been posted to the NGHP User Guide page, found here. The NGHP User Guide to version 8.0 replaces Version 7.9 which was released on January 17, 2025.

MMSEA III – April 7, 2025 – NGHP User Guide version 8.0 Downloads

Chapter 1: Introduction and Overview

The updates listed below have been made to the Introduction and Overview Chapter Version 8.0 of the NGHP User Guide. As indicated on prior Section 111 NGHP Town Hall teleconferences, the Centers for Medicare & Medicaid Services (CMS) continue to review reporting requirements and will post any applicable updates in the form of revisions to Alerts and the user guide as necessary. There are no changes for this version.

Chapter II: Registration Procedures

The update below has been made to the Registration Procedures Chapter Version 8.0 of the NGHP User Guide. As indicated in prior Section 111 NGHP Town Hall teleconferences, the Centers for Medicare & Medicaid Services (CMS) continue to review reporting requirements and will post any applicable updates in the form of revisions to Alerts and the user guide as necessary. To align with new WCMSA reporting requirements effective April 4, 2025, field numbers have been updated throughout this guide.

Chapter III: Policy Guidance

The updates listed below have been made to the Policy Guidance Chapter Version 8.0 of the NGHP User Guide. As indicated in prior Section 111 NGHP Town Hall teleconferences, the Centers for Medicare & Medicaid Services (CMS) continue to review reporting requirements and will post any applicable updates in the form of revisions to Alerts and the user guide as necessary. To align with new WCMSA reporting requirements effective April 4, 2025, field numbers have been updated throughout this guide.

Chapter IV: Technical Information

The updates listed below have been made to the Technical Information Chapter Version 8.0 of the NGHP User Guide. As indicated in prior Section 111 NGHP Town Hall teleconferences, the Centers for Medicare & Medicaid Services (CMS) continue to review reporting requirements and will post any applicable updates in the form of revisions to Alerts and the user guide, as necessary. A clarification has been added that the reporting threshold does apply to non-trauma no-fault and workers’ compensation cases (Section 6.4). The Event Table has been updated to include three new scenarios involving MSA corrections (Section 6.6.4). To align with new WCMSA reporting requirements effective April 4, 2025, field numbers have been updated throughout this guide.

Chapter V: Appendices

The updates listed below have been made to the Appendices Chapter Version 8.0 of the NGHP User Guide. As indicated in prior Section 111 NGHP Town Hall teleconferences, the Centers for Medicare & Medicaid Services (CMS) continue to review reporting requirements and will post any applicable updates in the form of revisions to Alerts and the user guide as necessary. To align with new WCMSA reporting requirements effective April 4, 2025, field numbers have been updated throughout this guide. To reflect improved reporting requirements, Zip+4 section guidance has been updated (Appendix A, Appendix B, and Appendix G). To ensure consistency of data, as of October 6, 2025, the Recovery Agent TIN field is required if agent name is submitted (Appendix B and Appendix G).

270/271 Health Care Eligibility Benefit Inquiry and Response Companion Guide for Mandatory Reporting Non-GHP Entities Version 6.0

The email address for contacting an Electronic Data Interchange (EDI) Representative has changed to COBVA@bcrcgdit.com. However, COBVA emails coming from CMS now show the address as COBVA@mail.cms.hhs.gov (Customer Support).

For Additional Information

Medivest will continue to monitor changes occurring at CMS and will keep its readers up to date when such changes are announced. For questions, feel free to reach out to the Medivest representative in your area by clicking here or call us direct at 877.725.2467.

 


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07/Jan/2025

On January 6, 2025, the Centers for Medicare & Medicaid Services (CMS) updated the MMSEA Section 111 NGHP User Guide to version 7.9. The newer version has been posted to the NGHP User Guide page, found here. The NGHP User Guide to version 7.9 replaces Version 7.8 which was released on December 6, 2024.

MMSEA III – January 6, 2025 – NGHP User Guide version 7.9 Downloads

Chapter 1: Introduction and Overview

The updates listed below have been made to the Introduction and Overview Chapter Version 7.9 of the NGHP User Guide. As indicated on prior Section 111 NGHP Town Hall teleconferences, the Centers for Medicare & Medicaid Services (CMS) continue to review reporting requirements and will post any applicable updates in the form of revisions to Alerts and the user guide as necessary. There are no changes for this version.

Chapter II: Registration Procedures

The update listed below has been made to the Registration Procedures Chapter Version 7.9 of the NGHP User Guide. As indicated on prior Section 111 NGHP Town Hall teleconferences, the Centers for Medicare & Medicaid Services (CMS) continue to review reporting requirements and will post any applicable updates in the form of revisions to Alerts and the user guide as necessary. There are no changes for this version.

Chapter III: Policy Guidance

The updates listed below have been made to the Policy Guidance Chapter Version 7.9 of the NGHP User Guide. As indicated on prior Section 111 NGHP Town Hall teleconferences, the Centers for Medicare & Medicaid Services (CMS) continue to review reporting requirements and will post any applicable updates in the form of revisions to Alerts and the user guide as necessary. As of January 1, 2025, the threshold for physical trauma-based liability insurance settlements will remain at $750. CMS will maintain the $750 threshold for no-fault insurance and workers’ compensation settlements, where the no-fault insurer or workers’ compensation entity does not otherwise have ongoing responsibility for medicals (Section 6.4).

Chapter IV: Technical Information

The updates listed below have been made to the Technical Information Chapter Version 7.9 of the NGHP User Guide. As indicated on prior Section 111 NGHP Town Hall teleconferences, the Centers for Medicare & Medicaid Services (CMS) continue to review reporting requirements and will post any applicable updates in the form of revisions to Alerts and the user guide, as necessary. As of January 1, 2025, the threshold for physical trauma-based liability insurance settlements will remain at $750. CMS will maintain the $750 threshold for no-fault insurance and workers’ compensation settlements, where the no-fault insurer or workers’ compensation entity does not otherwise have ongoing responsibility for medicals (Section 6.4).

Chapter V: Appendices

The updates listed below have been made to the Appendices Chapter Version 7.9 of the NGHP User Guide. As indicated on prior Section 111 NGHP Town Hall teleconferences, the Centers for Medicare & Medicaid Services (CMS) continue to review reporting requirements and will post any applicable updates in the form of revisions to Alerts and the user guide as necessary. There are no changes for this version.

270/271 Health Care Eligibility Benefit Inquiry and Response Companion Guide for Mandatory Reporting Non-GHP Entities Version 6.0

The email address for contacting an Electronic Data Interchange (EDI) Representative has changed to COBVA@bcrcgdit.com. However, COBVA emails coming from CMS now show the address as COBVA@mail.cms.hhs.gov (Customer Support).

For Additional Information

Medivest will continue to monitor changes occurring at CMS and will keep its readers up to date when such changes are announced. For questions, feel free to reach out to the Medivest representative in your area by clicking here or call us direct at 877.725.2467.

 


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17/Dec/2024

On December 16th, Centers for Medicare & Medicaid Services (CMS) announced that 2025 recovery thresholds for physical trauma liability, no-fault and Workers’ Compensation settlements, judgments, awards or other payments by CMS (Settlements) will remain at $750. The full announcement can be read here.

This threshold does not apply to ingestion, implantation or exposure Settlements. The $750 threshold will continue to apply to Workers’ Compensation and no-fault insurance settlements as long as the entities do not have ongoing responsibility for medicals.  As usual, there is no Section 111 reporting requirement for Settlements under $750, and CMS will not seek recovery for conditional payments/Medicare liens arising from below threshold Settlements.

Additional information regarding the methodology used to determine the threshold has been provided here.

For Additional Information

Medivest will continue to monitor news and updates from CMS, and will keep its readers up to date when important announcements are made. For questions about this chart or any other recent updates, feel free to reach out to the Medivest representative in your area by clicking here or call us direct at 877.725.2467.


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11/Dec/2024

On December 6, 2024, the Centers for Medicare & Medicaid Services (CMS) updated the MMSEA Section 111 NGHP User Guide to version 7.8. It has been posted to the NGHP User Guide page, found here. The NGHP User Guide to version 7.8 replaces Version 7.7 which was released on October 7, 2024.

MMSEA III – December 6, 2024 – NGHP User Guide Downloads 7.8

Chapter 1: Introduction and Overview

The updates listed below have been made to the Introduction and Overview Chapter Version 7.8 of the NGHP User Guide. As indicated on prior Section 111 NGHP Town Hall teleconferences, the Centers for Medicare & Medicaid Services (CMS) continue to review reporting requirements and will post any applicable updates in the form of revisions to Alerts and the user guide as necessary. There are no changes for this version.

Chapter II: Registration Procedures

The update listed below has been made to the Registration Procedures Chapter Version 7.8 of the NGHP User Guide. As indicated on prior Section 111 NGHP Town Hall teleconferences, the Centers for Medicare & Medicaid Services (CMS) continue to review reporting requirements and will post any applicable updates in the form of revisions to Alerts and the user guide as necessary. There are no changes for this version.

Chapter III: Policy Guidance

The updates listed below have been made to the Policy Guidance Chapter Version 7.8 of the NGHP User Guide. As indicated on prior Section 111 NGHP Town Hall teleconferences, the Centers for Medicare & Medicaid Services (CMS) continue to review reporting requirements and will post any applicable updates in the form of revisions to Alerts and the user guide as necessary. A new section has been added that discusses Workers’ Compensation Medicare Set-Aside Arrangements (WCMSAs), within the workers’ compensation TPOCs section (Section 6.4.4).

Chapter IV: Technical Information

The updates listed below have been made to the Technical Information Chapter Version 7.8 of the NGHP User Guide. As indicated on prior Section 111 NGHP Town Hall teleconferences, the Centers for Medicare & Medicaid Services (CMS) continue to review reporting requirements and will post any applicable updates in the form of revisions to Alerts and the user guide, as necessary. A new section has been added that discusses Workers’ Compensation Medicare Set-Aside Arrangements (WCMSAs), within the workers’ compensation TPOCs section (Section 6.4.4.1).

Chapter V: Appendices

The updates listed below have been made to the Appendices Chapter Version 7.8 of the NGHP User Guide. As indicated on prior Section 111 NGHP Town Hall teleconferences, the Centers for Medicare & Medicaid Services (CMS) continue to review reporting requirements and will post any applicable updates in the form of revisions to Alerts and the user guide as necessary. There are no changes for this version.

270/271 Health Care Eligibility Benefit Inquiry and Response Companion Guide for Mandatory Reporting Non-GHP Entities Version 6.0

The email address for contacting an Electronic Data Interchange (EDI) Representative has changed to COBVA@bcrcgdit.com. However, COBVA emails coming from CMS now show the address as COBVA@mail.cms.hhs.gov (Customer Support).

 

For Additional Information

Medivest will continue to monitor changes occurring at CMS and will keep its readers up to date when such changes are announced. For questions, feel free to reach out to the Medivest representative in your area by clicking here or call us direct at 877.725.2467.

 


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07/Oct/2024

On October 7, 2024, the Centers for Medicare & Medicaid Services (CMS) updated the MMSEA Section 111 NGHP User Guide to version 7.7. It has been posted to the NGHP User Guide page, found here. The NGHP User Guide to version 7.7 replaces Version 7.6 which was released on July 2, 2024.

MMSEA III – October 7, 2024 – NGHP User Guide Downloads 7.7

Updates: The updates listed below have been made to the Introduction and Overview Chapter Version 7.7 of the NGHP User Guide. As indicated on prior Section 111 NGHP Town Hall teleconferences, the Centers for Medicare & Medicaid Services (CMS) continue to review reporting requirements and will post any applicable updates in the form of revisions to Alerts and the user guide as necessary. The table describing system-generated emails has been updated to include information for the RRE ID Notification email that is sent once a user completes the initial registration function and the Successful Registration PIN email that is sent once vetting is successful on the Section 111 COB Secure Website (COBSW) (Table 7-1).

Updates: The update listed below has been made to the Registration Procedures Chapter Version 7.7 of the NGHP User Guide. As indicated on prior Section 111 NGHP Town Hall teleconferences, the Centers for Medicare & Medicaid Services (CMS) continue to review reporting requirements and will post any applicable updates in the form of revisions to Alerts and the user guide as necessary. The table describing system-generated emails has been updated to include information for the RRE ID Notification email that is sent once a user completes the initial registration function and the Successful Registration PIN email that is sent once vetting is successful on the Section 111 COB Secure Website (COBSW) (Table 6-4).

Updates: The updates listed below have been made to the Policy Guidance Chapter Version 7.7 of the NGHP User Guide. As indicated on prior Section 111 NGHP Town Hall teleconferences, the Centers for Medicare & Medicaid Services (CMS) continue to review reporting requirements and will post any applicable updates in the form of revisions to Alerts and the user guide as necessary. For clarification, a note has been added to indicate that settlements, judgments, awards, or other payments obtained entirely under the wrongful death theory of liability, which do not claim and release medicals, or have the effect of releasing medicals, are not required to be reported (Section 6.5.1.4).

Updates: The updates listed below have been made to the Technical Information Chapter Version 7.7 of the NGHP User Guide. As indicated on prior Section 111 NGHP Town Hall teleconferences, the Centers for Medicare & Medicaid Services (CMS) continue to review reporting requirements and will post any applicable updates in the form of revisions to Alerts and the user guide, as necessary. For NGHP claim files, a new “04” warning flag will be applied to claim response files with open ORM records when the later date of either the CMS Date of Incident on the claim record or the Part A Add Date is greater than 135 calendar days from the Start Date of the RRE’s submission period. Additionally, compliance flag fields have been renamed warning flag (Sections 6.1 and 6.9.1 and Chapter 7). The table describing system-generated emails has been updated to include information for the RRE ID Notification email that is sent once a user completes the initial registration function and the Successful Registration PIN email that is sent once vetting is successful on the Section 111 COB Secure Website (COBSW) (Table 12-1). The description of Response File disposition code 03 has been clarified (7.1).

Updates: The updates listed below have been made to the Appendices Chapter Version 7.7 of the NGHP User Guide. As indicated on prior Section 111 NGHP Town Hall teleconferences, the Centers for Medicare & Medicaid Services (CMS) continue to review reporting requirements and will post any applicable updates in the form of revisions to Alerts and the user guide as necessary. For NGHP claim files, a new “04” warning flag will be applied to claim response files with open ORM records when the later date of either the CMS Date of Incident on the claim record or the Part A Add Date is greater than 135 calendar days from the Start Date of the RRE’s submission period. Additionally, compliance flag fields have been renamed warning flag (Appendix C and Appendix G). The description of Response File disposition code 03 has been clarified (Appendix G).

Changes for This Release: The email address for contacting an Electronic Data Interchange (EDI) Representative has changed to COBVA@bcrcgdit.com. However, COBVA emails coming from CMS now show the address as COBVA@mail.cms.hhs.gov (Customer Support).

For Additional Information

Medivest will continue to monitor changes occurring at CMS and will keep its readers up to date when such changes are announced. For questions, feel free to reach out to the Medivest representative in your area by clicking here or call us direct at 877.725.2467.

 


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22/Jul/2024

On July 22, 2024 the Centers for Medicare & Medicaid Services (CMS) released their data for the Top 10 Section 111 Non-Group Health Plan Reporting Errors January – June 2024. The chart with the list of errors and their rank can be viewed below. A downloadable PDF of this chart along with an explanation of the error codes can be viewed here at the CMS website.

Medivest will continue to monitor news and updates from CMS, and will keep its readers up to date when important announcements are made. For questions about this chart or any other recent updates, feel free to reach out to the Medivest representative in your area by clicking here or call us direct at 877.725.2467.


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08/Jul/2024

On July 2, 2024, the Centers for Medicare & Medicaid Services (CMS) updated the MMSEA Section 111 NGHP User Guide version 7.6. It has been posted to the NGHP User Guide page on CMS.gov.  The NGHP User Guide version 7.6 replaces Version 7.5 which was released on April 1, 2024.  The updated MMSEA Section 111 NGHP User Guide version 7.6 has been posted to the NGHP User Guide page on CMS.gov.

MMSEA III – July 1, 2024 – NGHP User Guide Downloads 7.6

Updates:  An expanded and specific definition has been to clarify the qualification of a cumulative injury for Section 111 NGHP reporting. (Chapter 2).

Updates:  There are no changes for this version.

Updates:   The submission of information related to Workers’ Compensation Medicare Set-Aside Arrangements (WCMSAs) will be required for all records submitted with a TPOC date after April 4, 2025 (Section 6.5.1.1). As of January 1, 2024, the threshold for physical trauma-based liability insurance settlements will remain at $750. CMS will maintain the $750 threshold for no-fault insurance and workers’ compensation settlements, where the no-fault insurer or workers’ compensation entity does not otherwise have ongoing responsibility for medicals (Section 6.4).

Updates:  Information on how to resolve TIN address errors was added (Sections 6.3.3 and 6.6.5).

Updates:  An expanded and specific definition has been to clarify the qualification of a cumulative injury for Section 111 NGHP reporting (Section 3.2).

The language used to describe the date of incident and how a cumulative injury fits within that definition from CMS’ perspective with a caution note that CMS’ definition of cumulative injury is different from the insurance industry’s definition:

From Chapter 2, page 2-2, “CMS defines the Date of Incident (DOI) as follows:

  • The date of the accident (for an automobile or other accident);
  • The date of first exposure (for claims involving exposure, including; occupational disease, or any associated cumulative injury);
  • The date of first ingestion (for claims involving ingestion);
  • The date of the implant or date of first implant, if there are multiple implants (for claims involving implant(s); or
  • The earlier of the date that treatment for any manifestation of the cumulative injury began, when such treatment preceded formal diagnosis, or the first date that formal diagnosis was made by a medical practitioner (for claims involving cumulative injury).

Note: Cumulative injury refers to those categories of injuries that may persist or grow in severity, intensity, or pain but for which a formal diagnosis may not occur until a later date. Examples of cumulative injuries include, but are not limited to, carpal tunnel syndrome, or back pain that is not the result of an acute trauma. Exposure, ingestion, and inhalation injuries are not considered cumulative injuries for purposes of calculating DOI or any other reporting requirements. This CMS definition differs from the definition of that generally used by the insurance industry under specific circumstances. For the DOI used by the insurance and workers’ compensation industry, see Field 13 of the Claim Input File Detail Record in the NGHP User Guide Appendices, Chapter V.”

Updates:  The end-of-line character has been clarified for files using HEW software (270/271 File Translation).

 

For Additional Information

Medivest will continue to monitor changes occurring at CMS and will keep its readers up to date when such changes are announced. For questions, feel free to reach out to the Medivest representative in your area by clicking here or call us direct at 877.725.2467.

 


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15/Feb/2024

CMS has announced that it is maintaining the $750 Section 111 reporting threshold and the $750 Medicare Secondary Payer statute’s (MSP) recovery thresholds for 2024. CMS’s announcement that can be found here.

The CMS notification states, “Beginning January 1, 2024, the threshold for physical trauma-based liability insurance settlements will remain at $750. CMS will maintain the $750 threshold for no-fault insurance and workers’ compensation settlements, where the no-fault insurer or workers’ compensation entity does not otherwise have ongoing responsibly for medicals.

This means that entities are not required to report, and CMS will not seek recovery on settlements, as outlined above. Please note that the liability insurance (including self-insurance) threshold does not apply to settlements for alleged ingestion, implantation, or exposure cases.

Additional information regarding the methodology used to determine the threshold is also provided at the link to the announcement.

For Additional Information

Medivest will continue to monitor news and updates from CMS, and will keep its readers up to date when important announcements are made. For questions about this chart or any other recent updates, feel free to reach out to the Medivest representative in your area by clicking here or call us direct at 877.725.2467.


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23/Jan/2024

On January 22, 2024 the Centers for Medicare & Medicaid Services (CMS) released their data for the Top 10 Section 111 Non-Group Health Plan Reporting Errors July – December 2023. The chart with the list of errors and their rank can be viewed below. A downloadable PDF of this chart along with an explanation of the error codes can be viewed here at the CMS website.

Medivest will continue to monitor news and updates from CMS, and will keep its readers up to date when important announcements are made. For questions about this chart or any other recent updates, feel free to reach out to the Medivest representative in your area by clicking here or call us direct at 877.725.2467.


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