Claim Denial Rate Calculator

Calculates Target Probe and Educate (TPE) reviews, individual policy categories or overall Medicare dollar percentages



Claims and Appeals

Appeals - View details about the five levels in the Medicare appeals process.

Billing Situations - Information about Back-Up Equipment, Beneficiaries Entering Medicare, Consolidated Billing, DMEPOS and Inpatient Stays, Hospice, Indian Health Services (IHS), Medicare Advantage Plan, Medicare HMO Beneficiaries Transferring to Fee-For-Service Medicare and New Capped Rental Period.

Claim Submission - View information on assignment agreements, claim form instructions, mandatory claim submission, Medigap, signature requirements, timely filing and more.

Common Electronic Data Interchange (CEDI) - The CEDI contractor, National Government Services, provides a single electronic front end solution for all DME MAC suppliers.

CR9968 CURES Act Fee Schedule Adjustments - CMS has issued Change Request (CR) 9968 and related contractor instructions to begin mass adjustments for all claims impacted by the extension of the transition to the fully adjusted Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) payment rates under Section 16007 of the 21st Century Cures Act.

Healthcare Integrated General Ledger Accounting System (HIGLAS) - A financial accounting system will enable the Centers for Medicare & Medicaid Services (CMS) to track Medicare payments and to accurately pay claims for over 40 million Medicare beneficiaries

Medicare Secondary Payer (MSP) - Medicare Secondary Payer (MSP) is the term used to describe when another payer is responsible for paying a beneficiary's claims before Medicare pays. Noridian protects and preserves the Medicare Trust Fund by ensuring that Medicare benefits are coordinated with all other appropriate payers and Medicare pays only when and what it should pay.

Overpayments - View information on immediate offsets, voluntary refunds, Recovery Auditor overpayments, surety bonds and more.

Reopening - Prior to requesting an appeal, a provider may request changes due to clerical errors or omissions through the reopenings process.


Last Updated Tue, 11 Feb 2020 15:08:01 +0000

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