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08/Oct/2026

On October 5, 2026, the Centers for Medicare & Medicaid Services (CMS) released the MMSEA Section 111 NGHP User Guide to Version 8.6. The updated 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.

Summary of Updates

Chapter 1: Introduction and Overview

The updates listed below have been made to the Introduction and Overview Chapter Version 8.6 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.

Emails coming from COBVA@mail.cms.hhs.gov will now show the address as MSPCenter@cms.hhs.gov (Chapter 7).

Chapter II: Registration Procedures

The update listed below has been made to the Registration Procedures Chapter Version 8.6 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.

Emails coming from COBVA@mail.cms.hhs.gov will now show the address as MSPCenter@cms.hhs.gov (Chapter 6).

A non-submission notification email will be sent when a NGHP RRE fails to submit their Claim Input File within the last 6 months (Chapter 6).

Chapter III: Policy Guidance

The updates listed below have been made to the Policy Guidance Chapter Version 8.6 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.

Language has been updated to clarify when it is required to submit a record for wrongful death (Section 6.5.1.4).

Language has been updated to clarify the reporting exception for Qualified Settlement Funds (QSFs) (Section 6.5.1.8).

Chapter IV: Technical Information

The updates listed below have been made to the Technical Information Chapter Version 8.6 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.

Verbiage has been corrected for consistency regarding delete transaction threshold errors (Sections 7.3.2).

As of April 2027, the system will be updated to handle the removal of TPOC and WCMSA data when the existing TPOC or WCMSA data has non-zero values and is being updated to zero values for S111 ORM Workers’ Compensation and No-Fault claims (Sections 6.4.5 and 6.6.4).

Emails coming from COBVA@mail.cms.hhs.gov will now come from MSPCenter@cms.hhs.gov (Chapter 12).

A non-submission notification email will be sent when a NGHP RRE fails to submit their Claim Input File within the last 6 months (Chapter 12).

Effective April 2027, the NOINJ will no longer be an acceptable diagnosis code as there is no need to report a case with no injuries (Section 6.2.5.2).

Chapter V: Appendices

The updates listed below have been made to the Appendices Chapter Version 8.6 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 April 2027, the system will be updated to handle the removal of TPOC and WCMSA data when the existing TPOC or WCMSA data has non-zero values and is being updated to zero values for S111 ORM Workers’ Compensation and No-Fault claims (Appendix A and Appendix G).

Effective April 2027, the NOINJ will no longer be an acceptable diagnosis code as there is no need to report a case with no injuries (Appendix A and Appendix G).

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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06/Oct/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 4.7, dated October 5, 2026, of the guide includes the following changes:

    1. Version 4.7 of this guide includes the following changes: In order to address the many reasons a case may be ineligible for review, a new “Ineligible – Other” letter is now available.

To download a copy of the updated WCMSA Reference Guide Version 4.7, 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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28/Sep/2026

For many people, a Medicare Set-Aside (MSA) is unfamiliar until it becomes part of a settlement, and it usually comes with a variety of questions: Which medical bills will the account pay? What happens at the pharmacy? Who keeps track of the funds?

Medivest’s Member Services Team gathered the questions we hear most often from new members about professional MSA administration. Whether you are receiving an MSA or helping someone plan or manage the medical portion of their settlement, these answers will help explain what professional administration can look like in everyday life.


 

Q: What is professional administration of my Medicare Set-Aside amount?

A: You will have an advocate to help guarantee your Medicare benefits do not become jeopardized. You will have an assigned case manager to help answer any questions or concerns for the life of the account. You will receive a Medivest card (much like an insurance card) where all you need to do is present the card when receiving medical goods or services.

Medivest will handle all the billing, processing, and payment for your ongoing Medicare-allowable expenses. Medivest will interface directly with Medicare and medical providers so you don’t have to. Plus, Medivest will also grant access to pharmacy & DME discount networks so your MSA funds can last longer.

Q: How does it benefit me to have my Medicare Set-Aside professionally administered?

A: Peace of mind – Medivest takes responsibility for complying with Medicare rules and regulations so you don’t have to worry about your Medicare benefits. Medivest also deals directly with providers and insurance plans to adjudicate bills so you don’t have to.

Financial – Medivest has secured preferred pricing for pharmacy & DME expenses that will allow us to pay discounted rates most people could not achieve on their own. Medivest also has a medical claims staff to negotiate with providers.

Ease of use – Medivest issues you a Medivest ID card just like an insurance card. All we ask you to do is present the card when you receive medical goods or services. Medivest handles the payments and coordination of insurance plans so you don’t have to.

Q: How do I get my medical bills paid with professional administration?

A: You will receive a Medivest ID card just like an insurance card that we ask you to present when you receive medical goods or services. The ID card instructs the provider to seek payment from Medivest. Also, leading up to the activation of your account, Medivest will have contacted your treating physicians to input our information into their billing system.

Q: How are my medications covered?

A: With professional administration, you do not need to change anything regarding your medications. Where you pick up your prescriptions and who you see does not have to change. We ask that you present your Medivest ID card when picking up prescriptions. The provider will seek payment directly from Medivest.

Q: Who controls my Medicare Set-Aside funds?

A: Medivest is hired as a custodian of your MSA funds. That means the money is 100% yours; we are simply a hired advocate to manage the medical expenses the MSA account must pay. Medivest does not take any percentage of your MSA funds for our fees. In fact, Medicare does not allow any administration fees to be taken out of the MSA account. The funds are strictly intended for injury-related and Medicare allowable expenses.

Q: What happens if I run out of money and still need treatment?

A: When the account completely exhausts, Medivest will notify Medicare.  After a review to make sure the MSA funds were spent appropriately, Medicare will assume the role of primary payer. Your ongoing Medicare allowable expenses will be paid for by Medicare. Medivest will handle this transition from start to finish for you.

Q: Do you send me reports on the activity and balance in my account?

A: Yes, we do. We can send you accounting reports and updates as you wish. Remember, you will have an account representative to help with any questions or concerns you may have. There is no automated system or AI bots. You’ll deal with a real person.


 

During settlement, parties may establish an MSA, but questions often arise afterward as medical care and bills continue. Understanding who handles payments, tracks the account, and answers questions can help claimants and settlement professionals decide whether professional administration is a good fit.

If you have questions about an existing Medivest account or are considering professional administration for an upcoming settlement, our team is here to help. For questions, feel free to reach out to the Medivest representative in your area by clicking here or call us directly at 877.725.2467.

 


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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.


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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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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.

 


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14/Apr/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 4.5, dated April 13, 2026 guide includes the following changes:

1. Additional ZIP codes have been added to the table listing major medical centers (Appendix 7).

2. The CDC Life Table link has been updated (Section 10.3).

To download a copy of the WCMSA Reference Guide Version 4.5, 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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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.

 


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10/Mar/2026

When an injured worker resolves a third-party liability claim arising out of the same injury covered by workers’ compensation, the law prevents double recovery by granting the workers’ compensation carrier a credit against future benefits, commonly referred to as a “holiday.” During this period, the injured worker must use the portion of the third-party liability settlement allocated to future medical expenses before the work comp carrier resumes payment responsibility.

While the concept is legally straightforward, the practical implications can be complex, particularly when future medical exposure, allocation issues, and Medicare Secondary Payer (MSP) compliance are involved. Professional Administration can play a critical role in navigating this process by ensuring funds are properly managed and documented, protecting ongoing benefit eligibility, and reducing compliance risk for all parties.

What Is a Workers’ Compensation Holiday?

A workers’ compensation holiday typically occurs when an injured worker settles a third-party liability claim related to the same injury covered by workers’ compensation benefits. Common examples include motor vehicle accidents, property liability incidents, or other third-party negligence claims arising during employment.

Because a workers’ compensation carrier has a statutory right of reimbursement, part of any third-party settlement is used to satisfy its lien for benefits already paid. However, lien repayment does not end the carrier’s financial exposure. In many jurisdictions, the carrier is also entitled to a future credit against ongoing medical benefits.

During a workers’ compensation holiday, the carrier temporarily suspends payment of injury-related expenses, and the injured worker must use the allocated portion of the third-party liability settlement to cover those costs. Once the credited amount is properly exhausted, the carrier resumes responsibility and becomes the primary payer for covered benefits.

Why Worker’s Compensation Holiday Exists

As mentioned above, in a third-party recovery, the workers’ compensation holiday exists to prevent double recovery. When an injured worker obtains a liability settlement for the same injury covered by a workers’ compensation claim, the law does not permit simultaneous recovery of both settlement funds and ongoing work comp benefits for the same medical expenses.

Instead, the carrier receives a credit against future medical exposure, and the injured worker must first exhaust the settled future liability medical funds before workers’ compensation resumes primary payer. While the concept is simple in theory, it can be complex, particularly when allocation disputes, lien issues, future medical projections, and Medicare compliance are involved. For plaintiff attorneys, understanding of how the holiday functions is critical to structuring settlements that protect the client’s recovery while avoiding unintended post-settlement complications.

How Professional Administration Supports Compliance

Professional administration involves specialized third-party management of settlement funds allocated for future medical care during the workers’ compensation holiday and beyond. Rather than placing complex compliance responsibilities on the injured worker, a professional administrator provides oversight by:

Managing Medical Payments

Medical bills are reviewed and paid directly from settlement funds in accordance with Medicare guidelines.

Verifying Medicare-Covered Treatment

Only qualified injury-related expenses are approved, helping prevent improper spending.

Maintaining Accurate Accounting

Every payment is documented, creating a clear audit trail that demonstrates the proper use of settlement funds.

Handling Reporting and Recordkeeping

Required documentation is maintained to support MSP compliance in the event of Medicare review.

Monitoring Fund Exhaustion

When credited funds are properly depleted, documentation supports reinstatement of workers’ compensation benefits or Medicare coverage when appropriate.

Benefits of Professional Administration for Plaintiff Attorneys

In today’s increasingly compliance-driven environment, professional administration is not simply an added service; it is a proactive strategy that helps safeguard settlement outcomes long after litigation concludes. Understanding how the workers’ compensation holiday functions and planning for it properly can significantly impact both your client’s financial security and your firm’s risk exposure.

  • Professional MSA Administration helps ensure that settlement funds are properly allocated and documented
  • minimizing the risk of Errors & Omissions (E&O) claims
  • reducing potential malpractice exposure
  • preserving eligibility for needs-based benefits
  • providing peace of mind for both injured workers and plaintiff attorneys

And when the third-party liability funds are fully exhausted, Medivest can seamlessly transition to provide professional administration for the ongoing workers’ compensation claim as well, supporting compliance, simplifying claim management, and helping facilitate resolution if and when the carrier decides to move toward settlement.

About Medivest

Founded in 1996, Medivest is a national MSP compliance company and provider of settlement solutions. Our focus is assisting anyone settling a workers’ compensation or personal injury claim to understand their obligation to consider Medicare’s interests under federal law. Medivest provides pre- and post-settlement solutions that help mitigate exposure from that obligation. Contact us today at 877-725-2467 or contact us here.

 


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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.

 


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