CMS Issues New User Guide for Liability Insurance, No-Fault & Workers' Compensation

The Centers for Medicare and Medicaid Services (“CMS”) has issued a new version (Version 3.6) of the Liability Insurance (Including Self-Insurance), No-Fault Insurance, and Workers’ Compensation User Guide. There were no significant changes in the new User Guide; rather CMS updated the User Guide to incorporate CMS alerts which have been issued since the release of the prior User Guide.

Version 3.5 was issued on April 22, 2013 and was quickly replaced by Version 3.6 to correct an error in Version 3.5. The current version of the CMS User Guide provides for the following:

• For “Ongoing Responsibility for Medicals” reporting, the Alleged Cause of Injury, Incident or Illness Field (Field 15) will not be required.
• For the Non Group Health Insurance Plans Claim Input File, it will now be optional to enter the Claimant’s and/or Claimant's Representative’s Social Security and/or Employer Identification Numbers on the Claimant Information (Field 105) or Claimant Attorney/Other Representative Information (Field 123) sections.
  
  

Technical updates include:

• When a Claim Input File Detail Update Record is submitted without a settlement, judgment, award or other payment, the Disposition, Error and Compliance Flag Code will be returned.
• The CI25 Error description has been redefined and will only be returned if the No Injury code default code (”OINJ“) is not used properly. The CI25 error will be received in the following situations:
  • If the value "NOINJ" is submitted in the Alleged Cause of Injury field and something other than “NOINJ” is submitted in the ICD-9 Diagnosis Code 1 field; or
  • If the value “NOINJ” is submitted in the ICD-9 Diagnosis Code 1 field and another diagnosis code is also supplied. (Note: When the value ‘”NOINJ” is submitted, it must be the only diagnosis code supplied); or
  • If the value “NOINJ” is submitted in the ICD-9 Diagnosis Code 1 field and something other than “NOINJ” (or spaces) is submitted in the Alleged Cause of Injury field.
    
    

Click here to view Version 3.6 of the User Guide on the CMS website.

If you have questions or need additional information, please contact Marlene Wilson at Garretson Resolution Group at 704-559-4300 or at mwilson@garretsongroup.com.