On June 8th, CMS issued an Alert which states the following:
This alert serves as a reminder to NGHP Responsible Reporting Entities (RREs) that both Med Pay and Personal Injury Protection (PIP) coverage should be included when reporting the No-Fault Insurance Limit (Field 61 of Claim Input File). As such, NGHP RREs must combine both Med Pay and PIP coverage limits for a policy when they are separate coverages being paid out on claims for the same injured party and incident under a single policy. Recently it has come to our attention that some NGHP RREs are only including Med Pay when reporting the No-Fault Insurance Limit. If both Med Pay and PIP coverage limits are not reported, then the amount reported is not an accurate reflection of the policy limit. Ongoing Responsibility for Medicals should not terminate until both the Med Pay and PIP coverage limits are exhausted.
It is also important to accurately reflect two decimal places when reporting No-Fault Insurance Limit. For example, a policy limit of $5,000 should be reported as 500000.
Additional information can be found in the Non-Group Health Plan User Guide which is available on the NGHP User Guide page of CMS.gov.
Commentary: This alert is simply a reminder of guidance that was previously provided in the NGHP User Guide, but no doubt must have caused confusion for No-Fault carriers for CMS to have issued this Alert. Now is a crucial time for No-Fault payers to accurately report, as CMS looks to finalize its Rule regarding Civil Monetary Penalties (CMPs) that can be issued against noncompliant primary payers for up to $1000 per day/per claim. Ignorance or misapplication of the NGHP User Guide will not be an excuse to defend against CMPs as indicated under the Proposed Rule. To access our recent prior blog about this Proposed Rule, please click here. We are available for questions and can be reached at firstname.lastname@example.org.