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CMS releases new NGHP Section 111 user guide (Version 5.6)

The Centers for Medicare and Medicaid Services (CMS) has released an updated Section 111 User Guide (Version 5.6, July 1, 2019) regarding non-group health plans (liability, no-fault and workers’ compensation). This updated guide replaces Version 5.5 (January 7, 2019). 

CMS notes that changes have been made to Chapter II (Registration Procedures); Chapter IV (Technical Information), and Chapter V (Appendices). CMS provides a summary of the changes made in the beginning part of each Chapter.

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The new Version 5.6 updates are highlighted as follows:

  • Claim Input File - In Chapter II (Section 4.2.2), CMS now specifies that entities should submit one Claim Input file per quarter per RRE. While this change indicates only one file should be submitted, it is noted that CMS will still accept multiple claim file submissions. Thus, in this sense, this update can be viewed as reflecting CMS’s general preference that only one Claim File be submitted per quarter per RRE.
  • Response Files - In Chapter IV, CMS indicates that ‘response’ files will now remain on the Section 111 SFTP server for 60 days, as opposed to the previous retention period of 180 days. (Sections 10.3 and 10.4).
  • HIPAA Eligibility Wrapper (HEW) – Additional changes were made in Chapter IV regarding the HEW software. Specifically, CMS advises that Responsible Reporting Entities (RREs) may now download the latest version of the HEW software It is noted these identical updates are also referenced in Chapter V.

If you have any questions please contact Mike Gibbon at michael.gibbon@verisk.com, or Jeremy Farquhar at jeremy.farquhar@verisk.com.


Mark Popolizio, J.D.

Mark Popolizio, J.D., is vice president of MSP compliance, Casualty Solutions at Verisk. You can contact Mark at mpopolizio@verisk.com.


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