Version 5.9 of the NGHP User Guide is available for download here. Summary of version 5.9 updates:
- A reminder has been added that while the threshold for physical trauma-based liability insurance settlements remains at $750, this threshold does not apply to non-trauma liability reporting for alleged ingestion, implantation, or exposure cases. Any settlement, regardless of amount, should be reported for these types of cases. (Sections 6.4.2, 6.4.3, and 6.4.4).
- The limit dollar amount that triggers a threshold error has been adjusted from $99,999,999 to $99,999,999.99. This error occurs any time the No-Fault Insurance Limit amount or the cumulative value of all reported TPOCs (detailed and auxiliary records) exceed this limit. Additionally, the No-Fault Insurance Limit field number has been corrected under “Exceptions.” (Section 7.3.2).
- When considering the requirements for the Ongoing Responsibility for Medicals (ORM), remember, per current policy, that the dollar limit for No-Fault Insurance Limits (Field 61) represents a combined total of Med-Pay and Personal Injury Protection (PIP) (Section 6.7.1).
- Several no-fault excluded ICD-10 codes have been removed from the Excluded ICD-10 and ICD-9 Diagnosis Codes table (Appendix I).
- The CR02 claim response file error code field number has been corrected (Appendix F) (Table F-4).
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