Article Detail - JF Part A

In accordance with Internet Only Manual (IOM), Publication 100-09, CMS requires the use of self-service tools to verify all claim status and patient eligibility information. The use of these tools prevents unnecessary denials for providers and helps ensure proper payment of claims. To assist providers with these requirements, Noridian has created education about the following self-service tools.

• Noridian Medicare Portal (NMP)
• Interactive Voice Response (IVR)
• Provider Enrollment, Chain and Ownership System (PECOS)
• Remittance Advice (RA)
• National Plan and Provider Enumeration System (NPPES)
• Part A Noridian Custom Edits (NCE)

Examples of information available on these tools include:

• Claim Status information for all processed and pending claims (E.g., claim number, receipt date, and patient responsibility for denied and paid claims)
• Appeal rights, status, and letters
• Patient’s insurance and eligibility information
• Duplicate and overlapping claim information
• Provider’s enrollment information
• Local Coverage Determination (LCD) and National Coverage Determination (NCD) numbers.

Noridian encourages providers to ensure their staff working Medicare claims are familiar with these tools.

Resources:

• Tools
• NMP vs. IVR Self Service Elements Comparison
• CMS Internet Only Manual (IOM), Publication 100-09, Medicare Contractor Beneficiary and Provider Communications Manual, Chapter 6, Section 50.