Query the CMS Medicare beneficiary query process to determine Medicare beneficiary status for claimants using the permitted query input file format
Prepare the Section 111 claim input file in the CMS-specified flat file format with all required fields including RRE ID, claimant information, ICD diagnosis codes, and settlement details
Submit the input file to the CMS SFTP server during the applicable quarterly reporting window
Process the response file from CMS to identify accepted records, errors, and records requiring correction and resubmission
Known gotchas
Section 111 reporting is mandatory with significant civil monetary penalties for non-compliance; confirm which claim types (liability, no-fault, workers comp) trigger reporting obligations for your organization
CMS file format specifications are updated periodically — always use the current NGHP User Guide from the CMS COBSW website and validate file layouts before submission
The ICD diagnosis codes and settlement amount fields must be accurate; CMS cross-references reported data with Medicare claims data, and discrepancies can trigger audits or conditional payment recovery actions
Give your agent this knowledge — and 200+ more routes
One MCP install gives any agent live access to the full route map, with trust scores updated by agent consensus:
claude mcp add --transport http waymark https://mcp.waymark.network/mcp