ACT Questions and Answers - July 13, 2016

The information provided in this document is correct at the time of publishing. Prior to taking questions, Noridian provided the following updates.

Contractor Announcement

Noridian is proud to be your Medicare Administrative Contractor (MAC) for Jurisdiction A (JA). Noridian Healthcare Solutions has had a strong history with partnering with government agencies including Medicare since 1966 to improve program efficiency and enhance the quality and care to millions of beneficiaries each year. Currently Noridian is the DME MAC for Jurisdiction D, the A/B MAC for Jurisdictions E and F, the Pricing Data Analysis and Coding contractor (PDAC) as well as the NPI Enumerator contractor. Noridian was awarded the DME JA contract in part to our strong historical performance.

Noridian JA Website

The Noridian Medicare JA Website contains valuable resources including active LCDs and policy articles, a fee schedule lookup tool, appeals information, a schedule of educational events and more.

The "Education & Outreach" section of the website provides access to workshops, self-paced presentations, Q&A documents and quizzes. A series of web-based workshops to help suppliers become familiar with the Noridian website are available for registration. The workshops will provide an overview of the website layout, functionality and navigational options. We encourage you to visit the JA schedule of events to see the full listing of educational events available. While visiting our website or portal, you may be prompted to answer our Website Satisfaction Survey. Your completion of this survey provides Noridian valuable information and is used to help retain and prioritize what you like and make the changes you recommend.

Implementation Details

Noridian began administering the JA contract on July 1, 2016. We have resumed all workload from NHIC. This includes, but is not limited to, submitted claims, appeals, additional documentation requests (ADR), Advance Determination of Medicare Coverage (ADMC) and Prior Authorization Requests (PAR). Noridian does not anticipate any delays in the processing of these workloads.

A friendly reminder to suppliers, in order to expedite supplier questions as quickly and accurately as possible, any complex education questions should be directed to the Provider Outreach and Education (POE) Team. This can be done by filling out an education request form or by emailing JAQuestions@noridian.com. It is important to refer any general questions or claim specific questions to our Supplier Contact Center at 1-866-419-9458; M-F 8a.m.-5p.m. ET or email them to dmeA@noridian.com.

If you or your staff have many questions regarding the DMEPOS items you supply please consider requesting an electronic supplier visit. These visits allow our POE and MR staff the ability to work with you one-on-one and address all of your questions while providing education on the specific polices you work with.

Contact Information

Noridian has created a single toll free line where you will be able to access the Interactive Voice Response (IVR), the Supplier Contact Center and request Telephone reopenings. This single toll free line is now available. The number is 1-866-419-9458. The Noridian Mailing addresses, phone and fax numbers are also available on the Noridian Medicare website homepage.

Electronic and Paper claim submission

All electronic claim submitters will continue to go through CEDI as they do today. There will only be a change to the contractor workload number, which is now 16013. At this time we do not anticipate any other changes. We are aware that many suppliers are contacting us to verify that documentation was received. To clarify, all electronic claims under NHIC were held from June 30 - July 5. As of July 5, all electronic submission and processing resumed. If you submitted claims any time between June 30 and July 5, CEDI held them until July 5. All regular activities resumed on time on July 5. This holding pattern will not affect Noridian's payment standards.

If you are a supplier who has an ASCA waiver or meets the requirements to submit paper claims, you will want to use the Noridian mailing address immediately, as well as all other contact information (phone numbers, mailing addresses, fax numbers, etc.). As previously mentioned, visit the Noridian Medicare JA website for the full list of contact information. We will also include the listing in the meeting minutes.

All remittance notices now reflect Noridian. No other changes are anticipated. If you are already enrolled in electronic funds transfer, your information has been transferred from NHIC to Noridian. You will not need to fill out any additional paperwork. Any pending requests have also been transferred.

Medical Review

Noridian Medical Review staff conducts medical record reviews according to the CMS guidelines in the CMS Internet Only Manual (IOM). Noridian's goal is to reduce the claim payment error rate by identifying patterns of inappropriate billing through data analysis, performing medical review of claims and developing local policies to address program vulnerabilities. Reviews are based either on CMS requirements or data analysis findings. MR evaluates specific data findings, trend analysis reports, edit evaluation reports, national comparison reports, over utilization reports and Comprehensive Error Rate Testing (CERT) reports to make a determination on the type of reviews to be performed. Medical Review activities were implemented for JA on July 1.

ListServ

Suppliers who received NHIC email updates did not have to register for the Noridian Email updates. With CMS approval, the registration information was transitioned to Noridian. If you were not already registered with NHIC for email updates you can register for the Noridian email updates via the home page of our website.

Noridian Medicare Portal (NMP)

If you have not already registered to use the Noridian Medicare Portal (NMP), you are encouraged to do so. The Portal includes the ability to verify eligibility, claim status, financial information, submit appeals, as well as check claim status and more. To gain details regarding registration and how to use the portal functionality, we strongly recommend attending a web-based workshop, watching the brief DME on Demand tutorials, or reviewing the User Manual available under the "Browse By Topic / Noridian Medicare Portal" section of our website. We encourage you to visit the JA Schedule of Events to see the full listing of available educational events.

Appeals and Redeterminations

There will be a change to where you will submit your redeterminations and reopenings. We will offer three ways. These are the Noridian Medicare Portal, mail and fax. The specific mailing address and fax number for redetermination and reopenings are available right now on the website, and we will also include them in the meeting minutes.

Suppliers continue to have the normal appeal rights whether the claim was originally processed by NHIC or Noridian. Noridian will have both telephone reopenings and written reopenings for suppliers to correct those minor clerical errors or omissions.

KU Modifiers

Beginning July 5, 2016, suppliers have the ability to request a reopening for certain wheelchair accessories furnished in connection with Group 3 complex rehabilitative power wheelchair claims for dates of service on or after January 1, 2016, which were previously processed at the blended amounts. They will be adjusted to the fee schedule amount when a request to add the KU modifier is received by the DME MAC.

For those accessories billed to the DME MAC prior to July 1 which meet the criteria, the supplier must request the adjustment. A list of the accessories affected can be found in CMS Medicare Learning Network (MLN) Matters Special Edition (SE) 1614 - Implementation of Section 2 of the Patient Access and Medicare Protection Act

Noridian will accept a spreadsheet of codes however we request the following information be included.

Suppliers will need to utilize the Written Reopening Request form as the coversheet for the document. At the bottom in the comment section the supplier should state "Special Project Request -see attached spreadsheet" (give number of pages if more than one).

Ensure that the font be large enough to be easily read and include the following information regardless of the method submitted:

  • NPI/PTAN of supplier
  • Beneficiary Full Name
  • Medicare ID
  • Date of Service
  • HCPCS Codes
  • CCN
  • Reason for Reopening (you may state on your cover sheet/Written Reopening request to add the KU modifier for all)

Questions received prior to ACT meeting

Q: Will we need to submit paperwork to continue to get Electronic Funds Transferred (EFT) or will this be transferred from NHIC to Noridian?
A: If you have already enrolled in electronic funds transfer, that information has been transferred from NHIC to Noridian You should not have to fill out any additional paperwork. Any pending requests have also been transferred.

Q: Can I use my current billing software and clearinghouse to bill Noridian for JA?
A: All CEDI submitters will continue to go through CEDI.

Q: Would DME suppliers still be able to use the NHIC website for references to the medical policy center and Local Coverage Determination (LCD) information?
A: Typically, the outgoing contractor (in this case, NHIC) will remove their website following completion of the contract transition. Noridian will assume full contract operations on July 1, 2016. The new JA website from Noridian offers access to medical policy and education, as well as links to the LCDs and related Policy Articles under our "Policies" section.

Q: Will the National Supplier Clearinghouse (NSC) continue to process Durable Medical Equipment enrollment for providers in Jurisdiction A after the transition to Noridian?
A: There are no changes in the supplier enrollment process. You will continue to send the CMS-855S applications to the NSC.

Q: During registration for the portal, what information should I have available?
A: The Provider Administrator for your office must register first and they need to have the NPI, PTAN, Tax Identification Number (TIN), and the recent Check Number and Check Amount that is available by calling the IVR. Please call the IVR prior to registering to ensure the check number and amount you will be registering with is the same information the portal will be verifying. The CEDI-issued trading partner ID (also known as a submitter ID), is optional but no longer required during registration. People who will be doing inquiries for eligibility, claim status, etc. will not need the check number or amount during their registration and may register on their own as soon as the administrator has completed the process.

Q: Can I grant access to employees and conduct inquiries in the portal too?
A: If your company has 25 or less Full Time Equivalents, regardless of their position for your company, you can register as a Provider Administrator. After that is completed, you would be able to log into the portal and edit your account by submitting a request to change your role to an Administrator with End User access.

Q: Why do I have to enter the beneficiary's exact name and Medicare number?
A: Noridian often receives suggestions to allow a name or social security number search instead of requiring the beneficiary's Medicare Health Insurance Claim Number. Each Medicare contractor uses CMS' HIPAA Eligibility Transaction System (HETS) as the source for eligibility information for their portals. The CMS requirement to collect the name, date of birth and Medicare ID are defined by CMS.

Questions received During ACT meeting

Q: We've been experiencing issues with the portal not releasing same and similar information if there is a date of death on file. It makes it difficult to process claims that took place prior to the date of death, is there something that can be done so we can obtain that information?
A: This is a known issue based on a decision made by our contact center. This feedback has been shared with them and they are evaluating whether or not this functionality can be updated to release same and similar information when there is a date of death on file for the beneficiary. If any enhancements are able to be made to this functionality, notification will be made to the supplier community via our email listserv.

Q: When we previously used the PSP with NHIC, we were able to do a wild card search in same and similar with the letter followed by an asterisk, why can't we do that with the portal?
A: This is an enhancement to the portal and IVR we are currently researching. In addition, we are researching another enhancement to the portal concerning CMN/DIF status. Suppliers will be notified of any future enhancements to the portal and/or IVR via our email listserv.

Q: We've noticed the portal site has a slow response time, is there anything that can be done to improve this?
A: We are currently aware that logging in has an approximate response time of 10-15 seconds and claim status is approximately 20 seconds. Part of the reason for the slower response time on claim status is due to the fact that the system has to verify the beneficiary with the national file first and depending on those results, the portal will return the proper messaging. In addition, we've found same/similar also has a slower response time simply because the system has to search five years' worth of claims to determine any results. We are looking into ways we can speed up these transactions and appreciate any additional feedback suppliers may have concerning portal functionality.

 

Last Updated Feb 05, 2020