Article Detail - JA DME
NMP and/or IVR Use Required for Items Available Within These Self-Service Tools - Effective February 18, 2019
Effective February 18, 2019, Noridian will require suppliers to use the Noridian Medicare Portal (NMP) and/or the Interactive Voice Response (IVR) for all inquiries that are available in either of the Self-Service Tools. Until then, Customer Service Representatives (CSRs) will educate callers on these tools. If it is found that the reason for the call can be found on one of the Self-Service options, the CSR will direct the caller back out to use one of the options.
To access specifics about each, select the webpage links below.
Noridian Medicare Portal (NMP): Provides Part A and B effective and termination dates, deductible remaining, ineligible period (due to classified as unlawfully present, deported or incarcerated), beneficiary address, Managed Care Organization (MCO) and Health Maintenance Organization (HMO), Medicare Secondary Payer (MSP), Home Health Episode History (HHEH), Hospice, Hospital periods, Skilled Nursing Facility (SNF) periods
- See the Self Service Tools section of the DME On Demand webpage to get a better understanding of the options available
- Interactive Voice Response (IVR): Provides effective and termination dates, deductible information, Managed Care (HMO), MSP, home health, hospice, SNF periods, and date of death, general same/similar, claim status, overpayment info (with FCN), duplicate remits, inpatient stays, last checks, Power Mobility Device (PMD) Par, appeal status
The CMS Internet Only Manual (IOM), Publication 100-09, Chapter 6, Section 50.1 mandates that all providers first access inquiries through self-service technology, "...Providers shall be required to use the IVR system to access claim status and beneficiary eligibility information. CSRs shall refer providers back to the IVR system if they have questions about claims status or eligibility that can be handled by the IVR system.... Each MAC has the discretion to also require that providers use the Internet-based provider portal for claim status and eligibility inquiries if the portal has these functionalities."
This process change will allow Noridian to meet CMS requirements and our CSRs to assist callers with more complex inquiries which cannot be answered through these self-service tools.
CSRs are still able to assist with callers with the below as they are not currently available within any of the Self-Service tools. Note: List is not all inclusive.
- Policy issues
- Prior Authorization Request (PAR)/ Advance Determination of Medicare Coverage (ADMC) status checks
- Same/Similar over five years or eight for pumps
- Provider Enrollment Chain and Ownership System (PECOS) denials
- Complex financial issues
- NMP registration issues (May have to refer to User Security depending on complexity)
- Complex Certificate of Medical Necessity (CMN) and DMERC Information Form (DIF) denials
- Medical necessity denials
- Bundling denials
- Narrative denials
- Denials on an audit conducted by an outside contractor
Last Updated Wed, 05 Feb 2020 16:19:15 +0000