Attention Enrollees in the IVIG Demonstration
Earlier Enrollment Dates for IVIG Demonstration
Effective March 31, CMS has instructed that the enrollment dates for the IVIG demonstration will be changed to allow for earlier enrollment. Applications received from the first day through the fifteenth of the month, that are complete and meet the requirements for the IVIG demonstration, will be processed with an enrollment effective date of the first the following month. Applications received from the sixteenth day to the end of the month, will have an enrollment effective date of the 15 of the following month.
Enrollment application received on April 10. The beneficiary will be enrolled with an effective date of May 1. (This is not a change).
Enrollment application received on April 17. The beneficiary will be enrolled with an effective date of May 15. (In the past, the enrollment date would have been June 1).
This process will continue until we stop enrolling beneficiaries due to the end of this program in 2020, which will be November 15, or until we have enrolled 4,000 beneficiaries, whichever occurs first.
Information for Beneficiaries
Applications for participation in the IVIG Demonstration will continue to be accepted on a rolling basis until Medicare reaches or projects it will reach the statutory limit on funding and/or enrollment (4,000 beneficiaries). At this time, applications are still being received.
Please note that in order to be enrolled in the IVIG Demonstration, a beneficiary must:
- Be covered under Medicare Fee-For-Service and enrolled in Part B,
- Have a diagnosis of Primary Immune Deficiency Disease (PIDD), and
- Not be currently covered under a home health episode of care.
IVIG Demonstration Enrollment Application
All beneficiaries must complete and submit a signed application in order to be considered for this demonstration. The blank application may be printed and completed manually or filled in online and printed before signing. Once completed and signed by the beneficiary, the application must also be signed by the beneficiary's treating physician:
Your version of Adobe Acrobat may offer a feature to "digitally sign" the application document. Users should not use this feature as it does not properly qualify as a signature. Once completed, the application must be printed and signed with an ink pen.
IVIG Demonstration Enrollment Application Guide
These guides provide complete instructions for completing the IVIG Demonstration Enrollment Application.
Submitting the Application
By Fax - Completed IVIG Demonstration applications can be faxed to: 701-277-2428.
By Mail - Completed IVIG Demonstration applications can be mailed to:
Noridian Healthcare Solutions
PO Box 6788
Fargo ND 58108-6788
Noridian Healthcare Solutions
900 42nd St S
Fargo ND 58103
All IVIG Demonstration applicants will be notified within ten business days of receipt of a complete application of their status and the effective date of their coverage under the demonstration.
Effective Dates for Enrollment
Completed applications received by the 15th of the month, if eligible, will have coverage effective the first of the next month.
Completed applications received after the 15th of the month, if eligible, will have coverage effective the first date of the month following the next month. For example, if an application is received on September 15th, coverage will be effective October 1. If an application is received on September 20th, coverage will be effective November 1.
Last Updated Jun 07, 2016