Why Is My Claim Denied - JF Part B
Why Is My Claim Denied?
Your facility will receive a Remittance Advice (RA) that provides a short descriptor of the denial reason. We also provide a narrative detail reason on the reviewed claim in the Medicare claim system. You can access these comments in the Noridian Medicare Portal (NMP) under check Claim Status.
Accessing Medical Review Determination in Noridian Portal
The portal offers access to view claim processing comments if a claim had been selected for prepayment review in which Noridian requested documentation prior to making a claim decision. In the event a claim was not suspended during processing, this option will not be presented.
Noridian Medicare Portal End User Manual
Noridian Medicare Portal Registration Guide
- Perform a Claim Status Inquiry as described in the portal user manual.
- If the claim had a history of being reviewed for additional documentation, the portal will offer a "Noridian Comments" link in the claim header.
- After selecting this link, the claim processing comments will be retrieved and presented at the bottom of the Claim Status details.
Appealing a Denied Claim
Providers have the right to appeal a claim when not in agreement with the decision made by Medical Review. Appeals can be done at any time after a claim has been denied and do not need to wait for a case to close. Appeals must be done within 120 days after the determination date.
Refer to Appeals
