October Update to NGHP Section 111 Reporting User Guide

Today, the Centers for Medicare & Medicaid Services (CMS) published an updated NGHP User Guide (6.9). Chapters I – III of the NGHP User Guide remain unchanged, but Chapter IV (Technical Information) and Chapter V (Appendices) noted the following combined updates:

NGHP User Guide (version 6.9) – Chapter IV: Technical Information

The Section 111 excluded ICD-10 diagnosis codes for All Types (E, L, D) and for No-Fault Plan Insurance Type D have been removed from this guide (previously Appendices I and J). Excel spreadsheets of the ICD-9/ICD-10 excluded and valid codes for FY 2023 are now available for download on CMS.gov at https://www.cms.gov/medicare/coordination-benefits-recoveryoverview/icd-code-lists (Section 6.2.5).

NGHP User Guide (version 6.9) – Chapter V: Appendices

The SP31 error code has been restored. RREs will receive this error code when submitting

records with effective dates greater than 90 days prior to Medicare entitlement (Appendix F).

Sanderson Firm Commentary:

In this brief update, CMS has removed the excluded ICD-10 diagnosis codes from the NGHP User Guide appendices and now centrally warehouses these excluded codes on its online ICD Code Lists page.

Additionally, Responsible Reporting Entities (RREs) will again receive the “SP31” error code when a claimant record is submitted through Section 111 reporting, but the claimant will not be Medicare-entitled for more than 90 days. Of note, correcting the SP31 error code is not necessary, and the RRE may re-submit the record in the next quarterly file submission as instructed by the policy guidance.

CMS appears to be fine-tuning its guidance in anticipation of its proposed rulemaking on civil monetary penalties, which is expected to be finalized by February 2023. As noted in our most recent webinar, we strongly encourage RREs to evaluate their best practices on Section 111 reporting requirements as failure to properly comply will soon result in significant penalties to claims organizations. At Sanderson Firm, we serve as a Section 111 reporting agent and consultative expert for workers’ compensation, general liability, and no-fault insurers. For assistance with Section 111 reporting inquiries or any questions regarding this post, please do not hesitate to contact us.