As of October 1, 2018, both the Non-Group Health Plan (NGHP) User Guide and Workers’ Compensation Medicare Set-Aside (WCMSA) Reference Guide have been updated with minor changes. The updated NGHP User Guide can be found here and the updated WCMSA Reference Guide can be found here.

Below are summaries of the changes in both of the Guides:

NGHP User Guide:

  • To meet Section 111 requirements, a Paperwork Reduction Act (PRA) disclosure statement has been added to this guide.
  • The contact protocol for the Section 111 data exchange escalation process has been updated (Section 8.2).

WCMSA Reference Guide Changes:

  • As required by Section 501 of the Medicare Access and CHIP (Children’s Health Insurance Program) Reauthorization Act (MACRA) of 2015, CMS must discontinue all Social Security Number (SSN)-based Medicare identifiers and distribute a new 11-byte Medicare Beneficiary Identifier (MBI)-based card to each Medicare beneficiary by April 2019. All fields formerly labeled as “HICN” have been relabeled as “Medicare ID” and can accept either a HICN or the new MBI.
  • The link to the CDC Life Expectancy Table has been updated (Section 10.3).
  • The Verifying Jurisdiction and Calculation Method for medical reviews has been updated (Table 9-1 and Table 9-2).

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