CMS Updates NGHP Section 111 Reporting User Guide

By Barrye Panepinto Miyagi

On October 5, 2026, CMS updated the Non Group Health Plan (NGHP) Section 111 reporting User Guide. For an overview of Section 111 reporting and which entities are responsible for reporting, see our prior blogs here and here. The most recent update to the User Guide addresses several concepts, including settlements involving a Qualified Settlement Fund (QSF) and the Global Lien Resolution (GLR) process.

Key takeaways from the revised guidance include:

Reporting Exception for Qualified Settlement Funds: Section 6.5.1.8

Qualified Settlement Funds (QSFs) are frequently utilized in mass tort and class action cases for the purpose of receiving, holding, and managing litigation or judgment proceeds. The settlement process in a mass tort case is unique, usually involving three key administrative roles, Special Master, Fund Administrator, and Lien Resolution Administrator. Defendants and insurers may transfer funds to a QSF, per the terms of a Master Settlement Agreement, before settlement funds are allocated to individual plaintiffs and before defendants know if individual plaintiffs will accept a settlement. For obvious reasons, obtaining required Section 111 reporting data in a timely fashion may be a challenge for defendants and insurers.

Per CMS guidance, insurers or defendants are usually the Responsible Reporting Entity (RRE). The updated User Guide allows a QSF to serve as the RRE in situations where there are multiple entities funding the QSF, and multiple claimants receiving settlement funds from the QSF, such that it would be impossible to know precisely how much of each entity’s contributed funds were allocated to each claimant.

For the QSF to serve as the RRE, the following conditions must be met:

• The QSF must agree to take on the role of an RRE
• Two or more entities must fund the QSF
• The QSF must operate under section 468B of the IRC, “in connection with a state or federal bankruptcy proceeding”
• There can be no active Ongoing Responsibility for Medicals (ORM)
• The QSF must have full and sole responsibility to resolve and pay claims utilizing funds paid into the QSF
• The QSF must adjudicate and pay claims without review or approval of the entities that paid settlement funds into the QSF.  If the entity funding the QSF retains any right to adjudicate, review, or pay claims, that entity shall report as an RRE and cannot be included in the QSF reporting exception.

Practice Considerations: While allowing a QSF to serve as the RRE is a step in the right direction, clarification and additional revisions would benefit claimants, defendants, and CMS (which must manage conflicting reports on settlement information from claimants and defendants and coordination of benefits). By way of example only, CMS’ inclusion of “in connection with a state or federal bankruptcy proceeding” seems to impose a broad limitation on the QSF serving as the RRE.  In addition, if defendants may eventually have the ability to determine how much of their respective contributed funds were allocated to each claimant, is the QSF prohibited from serving as the RRE? In many cases, the QSF is best equipped to serve as the RRE, and all parties, as well as CMS, would benefit from one entity reporting the relevant data to CMS.

Global Lien Resolutions: Appendix G

GLRs may be implemented in mass tort cases to streamline and facilitate CMS’ recovery in settlement and judgment funds.  While GLRs have been utilized for quite some time, the July 2026 User Guide included the first reference to a GLR and provided: “Effective January 2027: New Disposition Code “GL” will result for a Claim Response File when a record is not accepted by the BCRC because it is part of a Global Resolution Settlement.” This brief update raised questions about reporting obligations and the reporting process in GLRs.

The October 2026 update to the User Guide explains that if a claimant is included in a GLR, and the RRE submits a Section 111 report of the RRE’s settlement with the claimant, CMS will return a disposition code of GL. This disposition code confirms that the record is recognized as part of a GLR. The disposition code indicates that CMS’ interest in the settlement is being resolved through the GLR process, rather than the traditional lien resolution process.

Practice Considerations: For GLRs that have been in place for quite some time (legacy GLRs), CMS may have provided written confirmation, outside of the confines of the User Guide, that the RRE’s Section 111 reporting obligations may be met pursuant to the terms of the GLR.   In more recent GLRs, CMS has required the RRE to Section 111 report despite the fact that the claimant was enrolled in a GLR. When determining reporting obligations for a claimant who is enrolled in a GLR, it is prudent to consult with legal counsel on Section 111 reporting obligations.

Wrongful Death Claims: Section 6.5.1.4

In cases involving the death of an injured party, the decedent and the decedent’s heirs may have viable causes of action. Recovery of the decedent’s damages, including decedent’s medical expenses, are usually included in a survival action.  The decedent’s heirs usually recover damages for their loss of consortium-type claims through a wrongful death action.  However, in some states, the decedent’s medical expenses are an element of damages in the wrongful death claim. The updated User Guide addresses this issue.

The User Guide cautions that sometimes complaints alleging wrongful death claims and related settlement documents are written in such a way that medicals are claimed and released or have the effect of being released, even though the parties did not intend that result.   Accordingly, RREs are required to report any wrongful death settlement unless: 1) the RRE is able to definitively determine that the relevant documents, state law, and common law do not permit recovery of medical expenses from the settlement, and 2) that medicals were not released or had the effect of being released.

Practice Considerations:  To evaluate Section 111 reporting obligations in a wrongful death claim, the RRE must determine if medical expenses are an element of damages under the applicable state law. RREs should also carefully review complaints and release documents to ensure the parties have not inadvertently included allegations or release terms that trigger reporting obligations.

Settlements That Should Not Be Reported – NOINJ Code: Section 6.2.5.2

Some settlements or judgments involve incidents for which there is no associated medical care and the injured party has not alleged a situation involving medical care.  This is frequently the situation with loss of consortium claims, errors or omissions liability claims, or certain types of employment-related claims.

CMS initially required RREs to report these types of claims with a diagnosis code of No Injury (NOINJ). Subsequently, CMS made the diagnosis code of NOINJ optional.  The updated User Guide provides that, effective April 2027, NOINJ will no longer be accepted as a diagnosis code. 

CMS cautions that RREs should continue to utilize all appropriate due diligence in attempting to identify any injuries and applicable ICD codes related to the incident. An inability to identify the exact ICD codes is not an appropriate reason to not report the total payment obligation to the claimant (TPOC) if an injury or illness was claimed and released.

Practice Considerations: In claims where medical expenses were not pled or released, the settlement documents should clearly reflect those facts.

Review of Response Files, Technical Requirements: Section 6.9.1

The User Guide includes the following additional instructions: It is important for RREs to review the response file from the BCRC to determine what records were accepted and what errors prevented the file from uploading.

Practice Considerations: Section 111 reporting is a technical process. There are numerous points at which the process may fail, meaning CMS may not receive or accept the report. CMS issues response files, which confirm receipt of and identify disposition codes reflecting how CMS interprets the report. It is prudent for RREs to review response files to ensure that Section 111 reports were submitted and accepted without errors. When working with a reporting agent, the RRE should keep in mind that CMS will look to the RRE, and not the reporting agent, if reports are not timely submitted.

Correcting and Removing Data in a Section 111 Report: Table 6-12

CMS provides guidance, effective April 2027, on how to correct TPOC and Workers’ Compensation Medicare Set-Aside data. The technical details on correcting these errors are found in table 6–12 of the User Guide.

Non-Submission Notification

If the RRE fails to submit a claim input file within the last six months, the account representative and account managers will receive a non-submission notification.

Practice Considerations: The non-submission notification serves as a helpful reminder for RREs to review their files, confirm that internal procedures are being followed, and verify that TPOCs and ORM are being timely reported.

How We Can Help: Taylor Porter’s Medicare Secondary Payer (MSP) Practice Group focuses on Section 111 reporting compliance, including Section 111 review and auditing services, drafting best practices for compliance with the MSP Act, settlement strategy, federal lien resolution, and training in-house, national, and local counsel. If you would like to consult with us, please reach out to Barrye Miyagi.