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CMS Updates Mandatory Insurer Reporting User Guide to Version 6.5

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CMS announced in an email on October 5, 2021 that it has released version 6.5 of its MMSEA Section 111 NGHP User Guide (the “User Guide”). MMSEA Section 111 (also known as Mandatory Insurer Reporting (“MIR”) continues to evolve as additional statutory obligations are added to the Medicare Secondary Payer. Many of the changes announced in this version of the User Guide relate to implementation of the PAID Act, effective December 11, 2021 and the information Responsible Reporting Entities (“RREs”) may receive with respect to a claimant.

Here is a chapter-by-chapter update on changes to the User Guide:

Chapter I – No updates made by CMS

Chapter II – As shared by CMS officials on prior Section 111 NGHP Town Hall teleconferences, CMS continues to review reporting in light of additional statutory amendments to the MSP Act. In light of the pending implementation of the PAID Act, CMS has authorized Direct Data Entry (“DDE”) reporters to use the beneficiary lookup function on the Section 111 Coordination of Benefits Secure Website (“COBSW”). Effective December 11, 2021, RREs will receive Medicare Part C (Medicare Advantage Plan) and Medicare Part D (Medicare Prescription drug coverage) enrollment information for the past three (3) years, as well as the most recent Part A and Part B entitlement dates, on the query response file from CMS.

Chapter III – CMS officials have clarified requirements around MIR when the date of incident (“DOI”) is prior to December 5, 1980. See Section 6.5.1.

Chapter IV – CMS now accepts records with MSP dates up to 3 months in the future. As such, CMS instructs RREs to no longer hold these records for submission when the beneficiary’s eligibility comes into effect. Where this action would have created a TN30 error in the past, CMS updated descriptions of the TIN Reference Response File process. See Section 6.3.3.

CMS also shared the following updates effective December 11, 2021. In light of the PAID Act, CMS will update the query response file to include: Contract Number; Contract Name; Plan Number; Coordination of Benefits (“COB”) Address; and Entitlement Dates for the last three years (up to 12 instances) of Medicare Part C and Medicare Part D coverage. The updates will also include the most recent Part A and Part B entitlement dates. CMS will also modify the HIPAA Eligibility Wrapper (“HEW”) software to extract the additional fields from the response file.

Chapter V – Within the appendix of the User Guide, CMS made changes consistent with those described above.

From all indications, CMS is ready to go with the obligations imposed on the agency due to the PAID Act. It has communicated process and policy changes timely and efficiently. Clearing this hurdle will now allow CMS to focus energy on other policy initiatives which include but may not be limited to regulations addressing future medical obligations under the MSP Act (the long awaited MSA regulations) and MIR civil monetary penalties. You can count on Cattie & Gonzalez to continue to provide you regular updates about CMS movement on these and other initiatives.

1 Comment

  1. BeckLawAdmin on January 10, 2022 at 7:25 pm

    Special thanks to John Cattie for providing this blog post!

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Kim Beck

Attorney Kimberly Beck

Cincinnati, Ohio

Attorney Kim Beck is the managing member of Beck Law Center, located in Cincinnati, Ohio.  She has 15 years of experience as an attorney, mostly on the defense.  She now represents plaintiffs in personal injury cases involving a variety of injuries caused by defecting drugs/ pharmaceuticals, medical malpractice, and other series accidents.  If you would like more information about her background and experience, please review her profile page.

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