Centers for Medicare & Medicaid Services (CMS)

8/8/2023 - 9 min read

CMS releases NGHP User Guide (Version 7.3) – updates include changes to the ORM trigger and CMS’s Unsolicited Response File process

The (CMS) has released an updated Section 111 NGHP User Guide (Version 7.3, August 7, 2023) regarding Section 111 reporting related to non-group health plans

6/28/2023 - 10 min read

Mid-Year “Round-Up” 2023 – keeping track of Medicare and other claims updates (ICYMI)

We are at the mid-point for 2023! It has been a busy year in so many claims areas. Time to regroup on the key claims updates over the past months – ICYMI style!

6/27/2023 - 5 min read

CMS’s Section 111 NGHP Unsolicited Response File “opt-in” process – Nutshell Summary Resource

CMS’s Section 111 NGHP Unsolicited Response File “opt-in” process – Nutshell Summary Resource. The following “Nutshell Summary” is a general summary of this process.

6/27/2023 - 22 min read

Understanding CMS’s Section 111 NGHP Unsolicited Response File “opt-in” process (starts July 2023) – Q&A resource (updated)

6/7/2023 - 11 min read

CMS holds webinar to discuss the Section 111 Non-Group Health Plan (NGHP) Unsolicited Response File “opt-in” feature (starts July 2023) and other Section 111 items

(CMS) held a webinar where the agency discussed its upcoming Section 111 Non-Group Health Plan (NGHP) Unsolicited Response File “opt-in” feature (starts July 2023)

6/7/2023 - 20 min read

CMS releases Section 111 NGHP User Guide (Version 7.2, June 5, 2023) – new changes include: NGHP Unsolicited Response File, ORM reporting trigger, ORM termination, and HEW software

(CMS) has released an updated Section 111 NGHP User Guide regarding Section 111 reporting related to non-group health plans.

6/7/2023 - 8 min read

The RAMP Act is re-introduced in Congress – bill proposes revisions to the MSP’s private cause of action (“double damages”) provision

On 5/16/23, (RAMP) Act was re-introduced into the U.S. House of Representatives, bill proposes revisions to the MSP’s private cause of action provision.

Gavel on a white background with a small shadow.

5/23/2023 - 9 min read

The United States District Court for Massachusetts dismisses a Medicare Advantage claim for “double damages” – rules that insurer’s Section 111 reporting does not establish standing to sue

The U.S. District Court for Massachusetts dismisses Medicare Advantage claim for “double damages”—rules insurer’s Section 111 reporting doesn't establish standing to sue.

5/18/2023 - 4 min read

CMS releases the WCMSA Reference Guide Version 3.9

CMS has made various updates to different aspects of its WCMSA process, including removing the time limit on Amended Reviews.

5/16/2023 - 1 min read

CMS to hold a Section 111 Non-Group Health Plan (NGHP) Unsolicited Response File Webinar on Tuesday June 6, 2023

5/16/2023 - 15 min read

CMS’s NGHP Unsolicited Response File “opt-in” process starts in July 2023 – Q&A, issues, and considerations

Earlier this year (CMS) formally announced a new non-group health plan (NGHP) Unsolicited Response File “opt-in” feature. Per CMS, this new process starts “July 2023”

5/3/2023 - 6 min read

CMS releases Non-Group Health Plan (NGHP) Applicable Plan Appeals Reference Guide (Version 1.0)

The Centers for Medicare and Medicaid Services (CMS) has released a Non-Group Health Plan (NGHP) Applicable Appeals Reference Guide (Version 1.0, April 27, 2023).