Tools - JA DME

Accessories and Supplies Used with Beneficiary-Owned Equipment - Requirements for beneficiary owned equipment when providing accessories and/or supplies and resolving denials

Acronyms and Glossary - Listing of common terminology but is not all-inclusive

Additional Documentation Request (ADR) Timeline Calculator - Calculate date Noridian must receive requested documentation

Administrative Law Judge (ALJ) Calculator - Calculate ALJ request submission deadline

Advance Beneficiary Notice of Noncoverage (ABN) Tutorial - Hover over form fields to identify details required for each

Appeals Decision Tree - Used to determine if a claim can be appealed

C-Peptide Calculator - A calculator to determine if C-peptide testing requirement criterion A1 or A2 are met

Capped Rental Monthly Payment Calculator - Find correct payment based on month and HCPCS of rented product

CERT Quick Look Documentation Tool - View guide of common Comprehensive Error Rate Testing (CERT) policies under review and documentation that is typically required for policy criteria to be met

Claim Denial Rate Calculator - Use this calculator to determine denial percentages for all supplier claims, including individual denial rate for Target Probe and Educate (TPE) review, denial rates for individual policy categories or determine overall Medicare dollar percentages denied

Claim Submission Timelines Calculator - Calculate claim submission deadline

Clinician’s Checklists - View checklists created specifically for clinicians to assist with ensuring that you complete the appropriate documentation needed when you prescribe durable medical equipment prosthetics, orthotics and supplies (DMEPOS) to your Medicare patients.

Clinician Resource Letters - Provide these letters to physicians to help them include and/or gather appropriate documentation

CMS-1500 Claim Form Tutorial - Hover over form fields to identify details required for each

Common Abbreviations to Use as Narratives - Utilize these common abbreviations when adding narratives for paper and electronic claims

Competitive Bid Area Zip Code Lookup Tool - Utilize the downloadable zip code file, CBA and Zip tab, on the DMEPOS Competitive Bidding Program website to determine if a zip code is included in a Competitive Bidding Area

Competitive Bid HCPCS Lookup Tool - This tool is intended to assist suppliers/providers with determining if a specific Healthcare Common Procedure Coding System (HCPCS) code is considered under the Competitive Bidding Program.

Consolidated Billing/SNF/Home Health/Hospice Lookup -Tool is intended to assist suppliers/providers with determining if a specific HCPCS is considered under consolidated billing for SNF, Home Health (HH) and Hospice

Continuous Glucose Monitor (CGM) Supply Allowance Calculator - Used to determine the next eligible date of service for billing CGM Supply Allowance HCPCS codes A4239 and A4238.

Continuous Passive Motion (CPM) Device Billing Span Dates Calculator - Calculator will assist suppliers determine how many days a device can be billed to the DME MAC after surgery is performed

Denial Code Resolution - View most common claim submission errors/descriptions, solutions, and ways to prevent them in the future

Documentation Checklists - View checklists to help identify records not routinely submitted by providers but must be available upon request

Enteral Nutrition Calculator - Determine correct number of units to submit Enteral Nutrition claims

Extended Repayment Schedule (ERS) Decision Tree - Provides a listing of the documentation needed with an ERS application depending on the length of the loan being requested

Face-to-Face and WOPD Required List HCPCS Code Lookup Tool - Determine which HCPCS codes require a Face-to-Face practitioner visit within six months preceding the order and the Written Order Prior to Delivery (WOPD) from the CMS Required List

Fee Schedule Lookup Tool - Find DMEPOS, Drug or PEN fees

IVR Conversion Tool - Determine touch-tone number sequence to enter in IVR

Medically Unlikely Edit (MUE) Lookup Tool - Helps to determine the maximum units of service that a provider would report under most circumstances for a single beneficiary on a single date of service

Medicare Secondary Payer (MSP) Decision Tree - Used to determine whether Medicare is primary or secondary

Medicare Secondary Payer (MSP) Payment Calculator - Enter specific amounts from primary insurance company's Explanation of Benefits in addition to their billed amount to determine Medicare's payment (line-level, not full claim billed amount)

Modifier Lookup Tool - Use this tool to assist in determining potential modifiers that may be used in billing DMEPOS HCPCS codes

Nebulizer Drug Calculators - Enter strength of drug, size of vial dispensed (if applicable) and frequency medication is taken to determine maximum number of units that can be billed in a 31 or 90 day period

New Supplier Training Opportunity Checklist - If you are new to Medicare and/or to Noridian, this checklist includes a comprehensive list of pre-recorded tutorial titles that can be accessed via our "DME on Demand" webpage.

Noridian Medicare Portal (NMP) - Access eligibility, claim status, same/similar, overpayments, Reopening/Redetermination submission and status inquiry, power mobility device prior authorization request status, and claim-specific Remittance Advices (RAs)

Off-The-Shelf or Custom-Fitted Orthotic Lookup Tool for Prefabricated Orthoses Only - Utilize this tool to assist in determining the correct HCPCS code in billing prefabricated orthotic claims.

Oral and Infusion Drug Calculators - Determine appropriate units of service to bill on a claim for oral anticancer, oral immunosuppressive, intravenous immune globulin (IVIG), and external infusion pumps (EIP) drugs.

Overpayment Decision Tree - Used to determine options for refunding Medicare overpayments

Overpayment Interest Calculators - These calculators are commonly used to determine how much interest have been accrued on an unpaid overpayment

Oxygen Modifier Decision Tree - Determine the appropriate modifier to use for oxygen.

Parenteral Nutrition Calculator - Determine correct number of units to submit Parenteral Nutrition claims.

PECOS NPI Lookup File - CMS ordering/referring provider downloadable report containing the NPI, first name, and last name of providers enrolled in PECOS, published quarterly. The file can be viewed online or be downloaded.

Pre-Claim Comparison Tool - View key differences between the Pre-Claim programs: Prior Authorization (PA) Program and Advance Determination of Medicare Coverage (ADMC)

Prior Authorization Lookup Tool - Determines which HCPCS codes require a Prior Authorization

Reconsideration Calculator - Calculate Reconsideration request submission deadline

Recovery Auditor Contractor Calculator - Calculate time frames for Recovery Auditor activities

Redetermination Calculator - Calculate Redetermination request submission deadline

Redetermination Request Checklist - Checklist for submitting a redetermination

Remittance Advice (RA) Tutorial - Hover over RA items to identify details of each field

Reopening Timeliness Calculator - Calculate Reopening request submission deadline

Round 2021 CBA Zip Code Lookup Tool - Determine if a zip code was included in a Competitive Bid Area (CBA), which CBA, and if it is included in the CMS Rural Zip code file.

Rural Zip Code File Lookup - Check the Zip Code to determine if it is a rural zip code for the date of service you are billing

Same or Similar Chart - Chart to provide guidance on Same or Similar items within a product category

Surgical Dressings Exudate and Wound Depth Lookup Tool - Determine type of dressings covered based on exudate and wound depth information

Surgical Dressings HCPCS Lookup Tool - Search by HCPCS to find dressing type, wound depth, exudate and usual dressing change information

Surgical Dressings Type Lookup Tool - Determine wound depth, exudate and usual dressing change by selecting a dressing type

Therapeutic Shoes for Persons with Diabetes Activity Timeline Tool - This tool will help assist suppliers in determining if the dates are within the timelines to meet the Therapeutic Shoes for Persons with Diabetes coverage criteria.

Upgrades - Upgrade scenarios, ABN requirements, required modifiers, and billing guidelines

Wheelchair Cushion Lookup Tool - This tool was designed to assist in determining if a beneficiary requires a skin protection, positioning, combination, or custom fabricated wheelchair cushion

WOPD and Face-to-Face Required List HCPCS Code Lookup Tool - Determine which HCPCS codes require a Written Order Prior to Delivery (WOPD) and Face-to-Face practitioner visit within six months preceding the order from the CMS Required List