The Centers for Medicare & Medicaid Services (CMS) has released Version 3.1 of its Non-Group Health Plan (NGHP) User Guide regarding its Mandatory Insurer Reporting directives.  NGHP User Guide (Version 3.1) consists of 279 pages and replaces CMS’ previous User Guide (Version 3.0).

CMS has made several amendments and modifications to its reporting guidelines in many areas.  Pages 6-8 of NGHP User Guide (Version 3.1) contain a summary of the applicable updates.  These updates should be carefully reviewed in their entirety to understand how same will affect RRE compliance obligations. 

Some of the key updates include: RRE determination (Section 7.1); requirement that RREs move to production status within 180 days after initiation of the registration process (Section 8.2, Step 5); use of the claimant’s HICN (Sections 11.1.1, 11.10.1 and 12); ICD-9 Codes (Section 11.2.5); reporting periodic WC and no-fault payments (Section 11.10.2); and updated directives regarding risk management “write offs” (Section 11.10.2) which supersede the prior guidelines contained in the agency’s May 26, 2010 Alert.

Click the 'full story' link below to obtain a copy of the NGHP User Guide (Version 3.1).

CMS’ May 26, 2010 Alert (RRE Directives)
Through this Alert, CMS revises Appendix G of its RRE directives as contained in its prior February 24, 2010 Alert.  The revisions relate specifically to CMS’ RRE directives concerning deductible amounts and reporting obligations under Section 111.  To view the alert, click here.

CMS’ May 26, 2010 Alert (Risk Management Write Offs)
CMS has announced its long awaited directives regarding when “risk management write offs” are reportable under Section 111.  In this Alert, CMS outlines the specific type of “write offs” that need to be reported as TPOCs, and the circumstances when such reporting may not be required per the TPOC monetary threshold reporting exceptions.  To view the alert click here.

CMS’ May 27, 2010 Alert (Periodic Payments)
CMS updates its directives as to when “periodic” workers’ compensation and no-fault payments (as that term is defined by CMS) are reportable under Section 111.  This Alert explains the situations in which the RRE will need to report qualifying “periodic” payments as ORM.  To view the alert click here.