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
IVIG Demo
PO Box 6788
Fargo  ND 58108-6788

Overnight Mailing
Noridian Healthcare Solutions
IVIG Demo
900 42^nd St S
Fargo ND 58103

Notification Process

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 fifteenth of the next month. For example, if an application is received on September 15, coverage will be effective October 1. If an application is received on September 20, coverage will be effective October 15.