Jun 12, 2020 by Bridget Smith, JD

CMS Issues New Section 111 Alert for Reporting No-Fault Insurance Limit on Non-Group Health Plan (NGHP) Claim Input Files

In this Alert dated June 8, 2020, CMS  reminds Non-Group Health Plan (NGHP) Responsible Reporting Entities (RREs)  that when reporting No-Fault Insurance Limits via Section 111 both Med Pay and Personal Injury Protection  (PIP) coverage limits should be included in this amount.  Specifically, CMS notes that when there are separate coverages being paid on claims for the same injured party and incident, both PIP and Med Pay limits should be reported as one combined amount.  CMS states that Ongoing Responsibility for Medical (ORM) should not be terminated until these policy amounts are exhausted.  CMS also provides a sample of how to correctly report these amounts. The full Alert can be found  here.

For further questions or for any of your Medicare compliance needs, please contact NuQuest’s Settlement Consultant Team at:  [email protected]