GHP User Guide

GHP User Guide

Information and instructions for the Medicare Secondary Payer (MSP) Group Health Plan (GHP) reporting requirements mandated by Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007 (MMSEA) (P.L. 110-173) are documented in the MMSEA Section 111 MSP Mandatory Reporting GHP User Guide (GHP User Guide).

The GHP User Guide is available in the Downloads section below, and is your primary source for Section 111 GHP reporting requirements. It is critical that each GHP Responsible Reporting Entity (RRE) read this guide prior to attempting to register for Section 111 reporting.

The GHP User Guide provides an overview of the related Section 111 legislation, MSP rules, entities that are required to report, and the GHP reporting process followed by detailed instructions and requirements. File specifications are located in its appendices. The first section of the GHP User Guide provides a list of updates made since the prior published version.

Comprehensive Computer-Based Training (CBT) modules covering all aspects of Section 111 reporting based on the GHP User Guide can be found on the GHP Training Material page.

Section 111 GHP Alerts

Frequently, CMS will publish new guidance in the form of an alert on the GHP Alerts page. These alerts are incorporated into subsequent versions of the GHP User Guide and supersede information published in the GHP User Guide. To obtain the most up to date information and requirements related to Section 111 reporting, be sure to review not only the GHP User Guide, but also any pertinent alerts published after the current version of the GHP User Guide.

Section 111 Coordination of Benefits Secure Website User Guide

The Section 111 Coordination of Benefits Secure Website (COBSW) is used by GHP RREs to register for Section 111 reporting, monitor file submissions, and submit online queries of Medicare entitlement. The user guide for this Web portal can be viewed and downloaded after logging in to the Section 111 COBSW. The link to the Section 111 COBSW can be found in the Related Links section below.

X12 270/271 Companion Guide

Section 111 GHP RREs have the ability to transmit a query file to request information regarding Medicare status and Medicare Part A entitlement and Parts B and C enrollment of individuals covered by the GHP.  This query file is submitted in the form of an ANSI X12 270/271 Entitlement Query transaction set.  If you choose to use your own ANSI X12 translator to create the X12 270 files for the Section 111 Query Only File and process the X12 271 response, please refer to the companion document which is available in the Downloads section below. This is to be used in conjunction with the National Electronic Data Interchange Transaction Set Implementation Guide and the Health Care Eligibility Benefit Inquiry and Response, ASC X12N 270/271 Implementation Guide. Please refer to the Query Only Input and Response File requirements in the GHP User Guide for more information.

Page Last Modified:
07/01/2024 04:50 PM