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

• Chapter I: Introduction and Overview (PDF)

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

• Chapter II: Registration Procedures (PDF)

Updates:  There are no changes for this version.

• Chapter III: Policy Guidance (PDF)

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).

• Chapter IV: Technical Information (PDF)

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

• Chapter V: Appendices (PDF)

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.”

• 270/271 Health Care Eligibility Benefit Inquiry and Response Companion Guide for Mandatory Reporting NGHP Entities, Version 5.9 (PDF)

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.