NGHP User Guide

NGHP User Guide

Information and instructions for the Medicare Secondary Payer (MSP) Non-Group Health Plan (NGHP) 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 Medicare Secondary Payer  Mandatory Reporting Liability Insurance (Including Self-Insurance), No-Fault Insurance, and Workers’ Compensation User Guide (NGHP User Guide). The NGHP User Guide is your primary source for Section 111 reporting requirements.

The NGHP User Guide is available as a series of downloads on this page. It is made up of five chapters: Introduction and Overview, Registration Procedures, Policy Guidance, Technical Information, and Appendices. Each chapter can be referenced independently, but are designed to function together to provide complete information and instructions for NGHP reporting. Chapter I: Introduction and Overview of the NGHP User Guide provides an overview of the related Section 111 legislation, MSP rules, and the NGHP reporting process. Detailed instructions, policy and requirements are provided in subsequent chapters. File specifications, error code documentation and other reference materials are located in Chapter 5: Appendices. The first section of each chapter provides a list of updates made since the prior published version.

It is critical that each NGHP Responsible Reporting Entity (RRE) read all chapters of the NGHP User Guide prior to attempting to register for Section 111 reporting.

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

Section 111 NGHP Alerts

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

Section 111 Coordination of Benefits Secure Website User Guide

The Section 111 Coordination of Benefits Secure Website (COBSW) is used by NGHP 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 NGHP RREs have the ability to transmit a query file to request information regarding the Medicare status of injured parties to help determine whether liability insurance, no-fault insurance or workers’ compensation claim information should be reported.  This query file is submitted in the form of an ANSI X12 270/271 Health Care Eligibility Benefit Inquiry and Response transaction set.  If you choose to use your own ANSI X12 translator to create the X12 270 files for the Section 111 Query File and process the X12 271 response, please refer to the Companion Guide 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 Input and Response File requirements in the NGHP User Guide for more information.

Page Last Modified:
07/01/2024 02:37 PM