Section 111 Reporting

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.

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.

5/1/2023 - 10 min read

CMS’s Query Process and non-binary/unspecified gender designations – current issues and considerations

Section 111 non-group health plan (RREs) involves the inability to submit non-binary or unspecified gender designations as part of the (CMS’s)

4/25/2023 - 17 min read

Second Circuit dismisses Medicare Advantage “double damages” lawsuit on standing grounds – rules the insurer’s Section 111 reporting did not establish liability

In an interesting new Medicare Advantage recovery decision, the United States Second Circuit Court of Appeals in MSP Recovery Claims.

3/21/2023 - 25 min read

Waiting for CMS’s Section 111 penalties “final rule” – status, updates, and what’s next

Presently, the industry is waiting for CMS to release its Section 111 CMPs “final rule” to the public.

2/22/2023 - 19 min read

CMS pushes back the timeline to release its Section 111 penalties “final rule” for one-year (until February 18, 2024)

In a major Section 111 development, (CMS) has extended the timeline to release its Section 111 civil money penalties (CMP) “final rule” until February 18, 2024.

2/7/2023 - 8 min read

CMS makes updates to Section 111 NGHP User Guide (Version 7.0) – updates relate to upcoming changes to the NGHP Unsolicited Response File

As reported in our recent article, in early January CMS released a new version of their Section 111 NGHP Section 111 User Guide (Version 7.0, January 9, 2023).

1/17/2023 - 6 min read

CMS releases updated Medicare Secondary Payer Recovery Portal (MSPRP) User Guide (Version 5.6) – Updates to Open Debt Report, Compromise Requests, and Go Paperless notifications

The Centers for Medicare and Medicaid Services (CMS) has released an updated Medicare Secondary Payer Recovery Portal (MSPRP) User Guide Version 5.6 (January 9, 2023).

1/12/2023 - 13 min read

CMS releases Section 111 NGHP User Guide (Version 7.0, January 9, 2023) – CMS announces several new updates to kick off 2023

The (CMS) has released an updated Section 111 NGHP User Guide (Version 7.0, January 9, 2023) regarding Section 111 reporting related to non-group health plans.

12/15/2022 - 4 min read

CMS retains its $750 “Low Dollar” threshold for 2023

The Centers for Medicare and Medicaid Services (CMS) has released its 2023 low dollar reporting and recovery threshold.

10/4/2022 - 7 min read

CMS releases Section 111 NGHP User Guide (Version 6.9) – updates relate to Section 111 excluded/valid diagnosis codes for 2023, SP31 error, and other items

6/30/2022 - 2 min read

Claims commitment: Empowering insurers on the innovation journey

The insurance industry has experienced tremendous change in the past few years.

3/3/2022 - 11 min read

CMS on the move: Section 111 civil money penalties Final Rule and Future Medicals proposals are pending review for release

The OIRA website indicates that CMS’s long-awaited S111 CMP “final rule” and their “Future Medicals” proposals are completed and are now pending OIRA review for release.

1/12/2022 - 4 min read

CMS releases Section 111 NGHP User Guide (Version 6.7) – new updates provide a GoPaperless option for Medicare Secondary Payer Recovery Portal users

CMS has released an updated Section 111 NGHP User Guide (V 6.7, Jan 10, 2022) regarding non-group health plans. This updated guide replaces Version 6.6 (Dec. 13, 2021).

11/11/2021 - 9 min read

CMS releases new NGHP Section 111 policy alert regarding the funding beyond the TPOC start date field

CMS “reminds” RREs to provide the actual or estimated date of funding in situations where funding of a TPOC will be delayed beyond the TPOC start date.