cms - Solutions for Workers' Compensation and Liability Settlements

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17/Jul/2026

On July 13, 2026, the Centers for Medicare & Medicaid Services (CMS) released the MMSEA Section 111 NGHP User Guide to version 8.5. The latest version has been posted to the NGHP User Guide page, which can be found here. Scroll down to the bottom of the page for each Chapter update.

MMSEA III – July 13, 2026 – NGHP User Guide v 8.5

Summary of Updates

Chapter 1: Introduction and Overview

The updates listed below have been made to the Introduction and Overview Chapter Version 8.5 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.

To eliminate false early and late alerts and emails, to reduce time spent investigating non-issues, and to reduce confusion and incorrect escalations, the Early File Submission and Late File Submission alerts and emails have been discontinued (Chapter 7)

Chapter II: Registration Procedures

The update listed below has been made to the Registration Procedures Chapter Version 8.5 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.

To eliminate false early and late alerts and emails, to reduce time spent investigating non-issues, and to reduce confusion and incorrect escalations, the Early File Submission and Late File Submission alerts and emails have been discontinued (Section 4.3.2 and Chapter 6).

To improve efficiency, files that have been in MSP HOLD (TIN) Error status or Severe Error status will automatically be deleted after 35 days (Chapter 6).

Chapter III: Policy Guidance

The updates listed below have been made to the Policy Guidance Chapter Version 8.5 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 updates to this chapter.

Chapter IV: Technical Information

The updates listed below have been made to the Technical Information Chapter Version 8.5 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.

To improve efficiency, files that have been in MSP HOLD (TIN) error status or Severe Error status will automatically be deleted after 35 days (Sections 6.3.3, 7.3.1, and 8.3).

To eliminate false early and late alerts and emails and to reduce time spent investigating nonissues, the Early File Submission and Late File Submission alerts and emails have been discontinued (Chapter 12).

The HEW software version language has been updated (Section 8.1).

Chapter V: Appendices

The updates listed below have been made to the Appendices Chapter Version 8.5 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.

Error code CW08 has been clarified to note that if the Claim Input File Detail Record is provided and does not match the existing WCMSA case, the record will be rejected (Appendix G).

Verbiage has been added to clarify that a member’s most current Medicare ID will be provided when a match is found (Appendix C and Appendix E).

Effective January 2027: New Disposition Code “GL” will result for a Claim Response File when a record is not accepted by the BCRC because it is part of a Global Resolution Settlement (Appendix G).

To reduce errors in address checks, it is no longer advisable to enter all zeros when entering a ZIP code when using the “FC” code (Appendix A, Appendix B, Appendix D, 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.

Medivest

14/Jul/2026

Centers for Medicare & Medicaid Services (CMS) has revised the WCMSA Reference Guide to reflect recent changes in CMS policy and Section 111 reporting requirements. Version 4.6, dated July 13, 2026, of the guide includes the following changes:

1. Language has been updated in the Approval Letter and Notice of Settlement Received Letter (Appendix 5).
2. The fax number has been updated (Appendix 5).

To download a copy of the WCMSA Reference Guide Version 4.6, click here.

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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Medivest

15/Apr/2026

On April 13, 2026, the Centers for Medicare & Medicaid Services (CMS) released the MMSEA Section 111 NGHP User Guide to version 8.4, revised on April 13, 2026. The latest version has been posted to the NGHP User Guide page, which can be found here.

MMSEA III – April 13, 2026 – NGHP User Guide v 8.4

Summary of Updates

Chapter 1: Introduction and Overview

The updates listed below have been made to the Introduction and Overview Chapter Version 8.4 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. Section 111 users can submit requests to their EDI Representative online in addition to phone and email correspondence (Chapter 7 and Section 8.1).

Chapter II: Registration Procedures

The update listed below has been made to the Registration Procedures Chapter Version 8.4 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. Section 111 users can submit requests to their EDI Representative online in addition to phone and email correspondence (Chapter 6 and Section 7.1).

Chapter III: Policy Guidance

The updates listed below have been made to the Policy Guidance Chapter Version 8.4 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. ORM Termination requirements have been updated (Section 6.3.2). TPOC reporting has been updated (Sections 6.4 and 6.5.1.2). Section 111 reporting requirements have been updated (Section 6.5.1.4). Guidance has been updated for submitting 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 8.4 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. Section 111 users can submit requests to their EDI Representative online in addition to phone and email correspondence (Chapter 12). The “as of” date has been removed since the implementation of the new change reason codes (Table 7-4). TPOC reporting has been updated (Section 6.4).

Chapter V: Appendices

The updates listed below have been made to the Appendices Chapter Version 8.4 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 updates to this chapter.

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.

Medivest

27/Mar/2026

CMS will be hosting a MMSEA Section 111 Mandatory Insurer Reporting webinar to discuss WCMSA reporting. The intent of the webinar is to review the WCMSA reporting process and data fields that were required effective April 4, 2025. CMS will also discuss some of the issues encountered, and review WCMSA reporting best practices.

All are welcome, but the intended audience for this webinar is the Section 111 reporting community (Responsible Reporting Entities (RREs) and Reporting Agents).

In advance of the webinar, participants are encouraged to email general questions related to Section 111 WCMSA reporting to the resource mailbox at PL110-173SEC111-comments@cms.hhs.gov. Requests for an accessible format of the presentation should also be sent to this resource mailbox.

Date: April 15, 2026
Time: 2:00 PM EST

Teams Join Link:
https://teams.microsoft.com/meet/22876272966889?p=WsvTXDWa93jTlz082i

Meeting ID: 228 762 729 668 89
Passcode: Wq2xz3Gm

OR to connect via telephone:

Conference Dial In: (888) 588-2610, 457579086# United States (Toll-free)
Phone conference ID: 457 579 086#

Important Note: This is a public webinar, and pre-registration is needed. The webinar link should only be utilized on the day of the webinar. Due to the number of expected participants, please log in at least 10 minutes prior to the start of the presentation.

Additional information on the most recent CMS updates can be found here. If you have questions on how topics discussed in this webinar may affect your clients or your company, please contact Medivest or call us at 877.725.2467.

Medivest

04/Mar/2026

CMS will be hosting a WCMSA Reporting Webinar. The webinar intends to review the WCMSA reporting process that was implemented in April 2025, discuss some of the issues encountered from CMS’s perspective, and review WCMSA reporting best practices. As parties impacted by the WCMSA reporting, we also welcome anyone else involved in the submission and administration of WCMSAs, including attorneys and Medicare beneficiaries, to join. Please bear in mind that this Webinar is intended to broadly address the WCMSA reporting process, and questions regarding specific cases are not appropriate for this setting.

In advance of the webinar, participants are encouraged to email general questions related to Section 111 WCMSA reporting to the resource mailbox at PL110-173SEC111-comments@cms.hhs.gov. Requests for an accessible format of the presentation should also be sent to this resource mailbox.

Date: Wednesday, March 25, 2026
Time: 1:00 PM EST

Teams Link: https://teams.microsoft.com/meet/22876272966889?p=WsvTXDWa93jTlz082i
Meeting ID: 228 762 729 668 89 Passcode: Wq2xz3Gm

OR to connect via telephone:

Conference Dial In: (888) 588-2610
Phone conference ID: 457 579 086#

Important note: This is a public webinar and there is no pre-registration needed. The webinar link should only be utilized on the day of the webinar. Due to the number of expected participants, please log in at least 10 minutes before the start of the presentation.

Additional information on the most recent CMS updates can be found here. If you have questions on how topics discussed in this webinar may affect your clients or your company, please contact Medivest or call us at 877.725.2467.

Medivest

09/Dec/2025

CMS will host a webinar regarding Certain Civil Money Penalties (CMPs) for the Non-Group Health Plan (NGHP) Responsible Reporting Entities (RREs). The CMS presentation will include reminders about the Final Rule and auditing process, anticipated correspondence, and will end with a question-and-answer session.

RREs are encouraged to submit questions in advance of the webinar to the dedicated resource mailbox at Sec111CMP@cms.hhs.gov.

Date: January 15, 2026
Time: 1:00 PM ET

Webinar Link: https://teams.microsoft.com/meet/23994683819593?p=5KeHzL9PqeKE8D11q3
Meeting ID: 239 946 838 195 93
Passcode: eD6Ep6E9

Or to connect via phone:

Conference Dial In: 1-888-588-2610
Conference Passcode: 167 106 458#

Important Note: This is a public webinar, and pre-registration is not required. The webinar link should only be used on the day of the webinar. Due to the number of expected participants, please log in at least 10 minutes prior to the start of the presentation.

Additional information on the most recent CMS updates can be found here. If you have questions on how topics discussed in this webinar may affect your clients or your company, please contact Medivest or call us at 877.725.2467.

Medivest

21/Nov/2025

On November 18, 2025, the Centers for Medicare & Medicaid Services (CMS) announced the 2026 Recovery Thresholds for Certain Liability Insurance, No-Fault Insurance, and Workers’ Settlements, Judgments, Awards, or Other Payments. To download CMS’ Recovery Threshold Alert, click here.

As required by section 1862(b) of the Social Security Act, CMS is required to review the costs related to collecting Medicare’s conditional payments and compare these to recovery amounts. Until further notice, the threshold for physical trauma-based liability insurance settlements will remain at $750. Until further notice, CMS will also 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.

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 claims.

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 directly at 877.725.2467.

Medivest

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.

Sandy Simpson

13/Nov/2025

Lien resolution is often an overlooked step in the settlement process. Nonresponsive lienholders, incomplete billing records, and the pressure to close a case quickly can easily push lien resolution to “tomorrow’s” to-do list. But delaying this step can have serious consequences – reducing the client’s net recovery and increasing the attorney’s potential risk exposure.

Handled incorrectly, liens can delay settlements, reduce client satisfaction, or even open the door to malpractice claims. Handled properly, they protect all parties, maximize recovery, and close cases with confidence.

That’s where ClearLiens by Medivest comes in. Our comprehensive lien resolution services are designed to help attorneys avoid common mistakes, stay compliant, and ensure clients receive the best possible outcomes. To illustrate why lien resolution matters so much, here is a list of five common mistakes attorneys make during the lien resolution process and how to avoid them.

1. Waiting Too Long to Address Liens

Mistake: Many attorneys focus on negotiating the best settlement first, leaving liens as an afterthought.

Risk: Liens don’t go away simply because a settlement is reached. Ignoring them until the end can stall settlement disbursement, leave attorneys scrambling to resolve last-minute issues, or even trigger accrued interest for the client due to failing to pay liens on time (Medicare).

Avoid Problems: Start identifying potential lienholders as early as possible by doing a lien investigation. Building lien resolution into your case workflow ensures there are no surprises when it’s time to disburse funds.

2. Failing to Identify All Liens Properly

Mistake: Overlooking certain lienholders, particularly government entities like Medicare, Medicaid or the Department of Veterans Affairs (VA), Medicare Advantage Plans (MAPs) Managed Care Organizations (MCO’s which are privately administered Medicaid), or any other private health insurance creates hidden risks.

Risk: Missing a lien can expose attorneys and clients to unforeseen repayment obligations, and for Medicare liens, heavy interest obligations, or even double damages. In some cases, the amount of an undiscovered lien can even exceed the settlement itself, leaving the client and, more likely, the attorney with a significant hurdle to overcome.

Avoid Problems: Implement a thorough intake and verification process to minimize potential issues. Ask clients detailed questions about their insurance coverage and treatment history, and confirm with all potential lienholders before closing the case.

3. Accepting the First Payoff Amount Without Question

Mistake: Paying whatever amount the lienholder initially demands.

Risk: Many lien demands include unrelated charges or fail to account for reductions due to case-specific factors, such as comparative fault or limited policy limits. Paying in full without review can unnecessarily reduce your client’s net recovery.

Avoid Problems: Always request an itemized statement and review the detailed payment spreadsheet carefully. Challenge unrelated or inflated expenses and negotiate reductions. Lienholders are often willing to compromise when presented with evidence of financial hardship, pre-existing medical conditions, or legal grounds for reduction.

4. Ignoring Compliance Requirements (Especially Medicare)

Mistake: Skipping or mishandling compliance obligations, such as reporting to the Centers for Medicare & Medicaid Services (CMS).

Risk: Failing to follow Medicare’s strict notification and repayment timelines can result in significant interest obligations or potential penalties, and can create unnecessary liability for your firm.

Right of Action Against “Any Entity”

The MSP statute gives Medicare the right to pursue recovery from any party that paid the claim or received a portion of the settlement funds as well as providers who received payment for services related to the compensated claim. This includes the claimant, attorneys, and even insurers in some cases.

Double Damages Penalty

If Medicare has to take legal action to recover, the statute allows it to seek double its damages (the amount it paid conditionally minus procurement costs), plus interest.

Avoid Problems: Treat Medicare compliance as a non-negotiable requirement. Familiarize yourself with CMS guidelines or partner with a professional lien resolution provider, such as Medivest, to ensure all requirements are met accurately and on time.

5. Ignoring Compliance Requirements (Especially Medicare Not Educating Clients About Liens Obligations and Timelines)

Mistake: Waiting until after settlement to explain lien obligations and the time it may take to resolve them.

Risk: Clients are often surprised to learn that a significant portion of their settlement will be directed toward healthcare liens. Even more frustrating, lien resolution is not always a quick process. While some liens can take as little as 60 days, others may stretch close to a year, depending on the complexity and the responsiveness of the lienholder. This lack of transparency can leave clients feeling blindsided, dissatisfied, and distrustful, which may lead to strained relationships or even formal complaints.

Avoid Problems: Set clear expectations with clients from the start. Explain both the financial impact of liens and the possible timelines for resolution. By discussing upfront that lien resolution is a necessary, and sometimes lengthy, part of the process, you build trust, manage expectations, and help clients stay patient and informed while waiting for their settlement funds to be finalized.

Conclusion: Protecting Clients, Protecting Your Practice

Lien resolution is far more than a box to check at the close of a case. It’s a critical component of risk management and client advocacy. By addressing liens properly and avoiding common mistakes, attorneys can maximize client recoveries, reduce delays, and protect themselves from unnecessary liability.

If lien resolution feels overwhelming or time-consuming, you don’t have to handle it alone. ClearLiens by Medivest, specializes in navigating the complexities of Medicare, MAP, Medicaid, MCO, VA, TriCare, FEHBA/FELA, ERISA, Hospital/Private Healthcare, and other healthcare-related liens. Partnering with our team helps ensure compliance, streamlines the resolution process, and safeguards both your clients and your practice.

For questions or to get started on a case today, visit us here to request more information.

Medivest

11/Sep/2025

CMS will be hosting a Workers’ Compensation Medicare Set-Aside (WCMSA) Reporting Webinar. The intent of this webinar is to review the WCMSA reporting process that was implemented this past April, as well as to discuss, from CMS’s perspective, some of the issues encountered as well as WCMSA reporting best practices. As parties impacted by the WCMSA reporting, we also welcome anyone else involved in the submission and administration of WCMSAs, including attorneys and Medicare beneficiaries, to join. Please bear in mind that this Webinar is intended to broadly address the WCMSA reporting process, so questions regarding specific cases are not appropriate for this setting.

In advance of the webinar, participants are encouraged to email the resource mailbox at PL110-173SEC111-comments@cms.hhs.gov with:

General questions related to Section 111 WCMSA reporting.
Requests for an accessible format of the presentation.

Date: October 1, 2025
Time: 2:00 PM ET

Webinar Link: https://cms.zoomgov.com/j/1607432331?pwd=uzRatck4qfC98K6rGbMp3DUtZ3Efy1.1
Passcode: 932824

Or, to connect via phone:

Conference Dial In: 1-833-435-1820
Conference Passcode: 160 743 233

Important Note: This is a public webinar and there is no pre-registration. The link above will not be active until the day of the webinar.

Additional information about the most recent updates from CMS can be found here. If you have questions on how topics discussed in this webinar may affect your clients or your company, please contact Medivest or call us at 877.725.2467.