CMS Updates Section 111 NGHP User Guide

On Tuesday October 5th the Centers for Medicare & Medicaid Services (CMS) published version 6.5 of the NGHP User Guide. There are a number of substantive changes, although nothing earth-shattering.  As with prior key updates, ExamWorks Compliance Solutions is here to give you all the important details on what has changed in this version. Here… Read more »

Minor Change at CMS Should Result in Quicker Claim Acceptance

On Monday, September 27, 2021, the Centers for Medicare and Medicaid Services (CMS) announced a minor, yet impactful change to their Section 111 processes.  October 4, 2021, CMS will accept a claim when the MSP effective date is up to three months in the future.  In turn, the CMS system will create an MSP record… Read more »

CMS Town Hall Meeting Addresses PAID Act

On Wednesday, June 23, 2021, the Centers for Medicare and Medicaid Services (CMS), hosted a town hall presentation regarding the PAID Act and its implications to the Section 111 Process.  The transcript of today’s call will be available on the CMS.gov website in roughly 2 weeks. While there were no significant updates or changes based… Read more »

“Soft” Edits Debut Today in Section 111 Reporting

Today marks the first significant update in Section 111 reporting logic in several years.  In November 2020 the Centers for Medicare and Medicaid Services (CMS) announced a new classification of “soft” edits that will take effect today (April 5, 2021).  The information below outlines what “soft” edits are and how they will change the way… Read more »

The PAID Act: Offering Hope to Coordinate Medicare Advantage Claims

On December 11, 2020, the MARC Coalition succeeded in its efforts to have Congress enact the Provide Accurate Information Directly (“PAID”) Act, filling a gaping hole in the MSP claims resolution process related to Medicare Advantage Organizations and Part D Plans (collectively “MAOs”).  The new law, included as section 1301 of H.R. 8900 (116th Congress,… Read more »

CMS Announces Joint NGHP Town Hall with CRC and BCRC

The Centers for Medicare & Medicaid Services (CMS) announced on February 25, 2021 an upcoming joint town hall with both The Benefits Coordination & Recovery Center (BCRC) and The Commercial Repayment Center (CRC).  The town hall will take place on Thursday April 1, 2021 at 1:00 PM EST.  The town hall will focus on questions… Read more »

CMS Announces Section 111 Technical Updates

On Thursday, January 21, 2021 the Centers for Medicare & Medicaid Services (CMS) released an updated Section 111 NGHP User Guide (back-dated to January 11, 2021).  While it contained nothing earth-shattering, there are a few important updates of note. CMS will now accept a claim with an ORM Termination Date that is up to 75… Read more »