The NGHP User Guide is designed to provide comprehensive information on the Medicare Secondary Payer (MSP) Non-Group Health Plan (NGHP) reporting requirements.
These requirements are mandated by Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007 (MMSEA).
Structure of the Guide
Comprises five chapters:
Introduction and Overview: Overview of Section 111 legislation, MSP rules, and reporting process.
Registration Procedures: Guidelines on how to register for reporting.
Policy Guidance: Detailed instructions and policy requirements.
Technical Information: File specifications and error code documentation.
Appendices: Reference materials and updates.
Each chapter provides updates from the previous version.
Importance of the Guide
Essential for each NGHP Responsible Reporting Entity (RRE) to read all chapters before registration.
Comprehensive Computer-Based Training (CBT) modules available based on the guide.
Section 111 NGHP Alerts
New guidance published as alerts on the NGHP Alerts page.
Alerts are incorporated into subsequent guide versions.
Important to review alerts for up-to-date information.
Coordination of Benefits Secure Website
Used by NGHP RREs for:
Registering for Section 111 reporting.
Monitoring file submissions.
Submitting queries of Medicare entitlement.
X12 270/271 Companion Guide
Allows NGHP RREs to request Medicare status information of injured parties.
Submissions are done via ANSI X12 270/271 transaction set.
Companion Guide available for download for additional guidance.
Downloads
Version 8.0 of the NGHP User Guide is available in PDF format, covering all chapters.
Related Links
Access to the Section 111 Coordination of Benefits Secure Website for further tools and registration.
Updates and Modifications
Page last modified on April 7, 2025.
Contact and Support
CMS offers various platforms for connection, including LinkedIn, YouTube, Facebook, Twitter, and RSS Feeds.
Managed by the U.S. Centers for Medicare & Medicaid Services located in Baltimore, MD.