Supplier Manual

The information previously consolidated into Supplier Manual Chapters is now located in the website for improved access to individual topics. The contents of each chapter with hyperlinks to access individual topics is provided below.

Chapter	Contents
Chapter 1 Introduction	What is Medicare? Noridian' Role as a DME MAC Medicare Card Railroad Retirement Board (RRB) United Mine Workers Association (UMWA)
Chapter 2 Supplier Enrollment	National Provider Identifier (NPI) National Supplier Clearinghouse Enrollment Site Visit Supplier Standards Accreditation Quality Standards Surety Bond Electronic Funds Transfer Changes to Application Do Not Forward Revalidation Revocation Participating/Non-Participating Medicare Participating Suppliers Directory Supplier Audit and Compliance Unit
Chapter 3 Documentation Requirements	Supplier Documentation Orders (including PECOS Edits, Nurse Practitioners or Clinical Nurse Specialist Rules Concerning Orders and CMNs, and Physician Assistant Rules Concerning Orders and CMNs Dispensing Orders Affordable Care Act (including Face-to-Face, detailed written order, and five-element order) Detailed Written Orders (including reminders) Requirement of New Orders Medical Record Information Continued Use and Continued Medical Need Documenting Repair Claims Refill Documentation Beneficiary Authorization Proof of Delivery Beneficiaries Entering Medicare Advance Beneficiary Notice of Noncoverage (ABN) Miscellaneous Documentation Issues (Delivery Fees) Same/Similar Equipment and ABNs Pick-up Slips Starting a New Capped Rental Period Back-Up Equipment Medicare HMO Beneficiaries Transferring to Fee-For-Service Medicare Comprehensive Error Rate Testing (CERT)
Chapter 4 Certificate of Medical Necessity (CMN)/DME Information Form (DIF)	Instructions for Completing a CMN and DIF CMN Cover Letters Transmission of CMN Changes to Completed CMN Physicians Charging for CMN Completion CMNs as Orders and Claim Submission Evidence of Medical Necessity for Oxygen CMN CMN – Common Scenarios
Chapter 5 DMEPOS	Inexpensive or Other Routinely Purchased DME Items Requiring Frequent and Substantial Servicing Customized Items Other Prosthetic and Orthotic Devices Capped Rental Items Oxygen and Oxygen Equipment Repairs, Maintenance and Replacement Parenteral/Enteral Nutrition Therapy Place of Service Consolidated Billing DMEPOS and Inpatient Stays
Chapter 6 Claim Submission	Definition of a Claim for Payment Mandatory Claim Filing Assignment Agreement Participation Program Beneficiary Signature Requirements CMS-1500 Claim Form Clean Claims – Payment/Interest Incomplete or Invalid Claims Processing Terminology Time Limit for Filing Claims Medicare Advantage Plans Hospice Consolidated Billing Medically Unlikely Edits Upgrades
Chapter 7 Crossover Claims	Crossover Claims Medigap
Chapter 8 Electronic Data Interchange	CEDI Help Desk Benefits Steps to Billing Electronically
Chapter 9 DMEPOS Coverage, Benefit Categories, and Medical Policy	General Medical Policy Information Local Coverage Determination and Policy Article Overview LCD Reconsideration Process National Coverage Determinations Advance Determination of Medicare Coverage (ADMC) DMEPOS Benefit Categories Citations for DMEPOS Benefit Categories
Chapter 10 Indian Health Services	Enrollment Facility Requirements Assignment of Specialty Codes Guidelines Claims
Chapter 11 Medicare Secondary Payer	Coordination of Benefits Information Gathering and Identifying Beneficiary Insurance Coverage MSP Payment Calculation MSP Overpayment Refunds MSP Claim Filing Tips
Chapter 12 Pricing	Fee Schedules Drug Pricing
Chapter 13 Reopenings and Appeals	Reopenings Redeterminations Reconsiderations Administrative Law Judge Appeals Council Federal Court Review Parties to Appeals
Chapter 14 Fraud and Abuse	Fraud Abuse Reporting Penalties
Chapter 15 Overpayments and Refunds	Recoupment Process Immediate Recoupment Process / Immediate Offset Requests Offset Requests Voluntary Refunds Refund of Excess Recoupments Overpayment Rebuttals Referral of Delinquent Debt Extended Repayment Schedule Recovery Auditor Overpayments
Chapter 16 Coding	Pricing, Data Analysis and Coding Modifiers
Chapter 17 System Outputs	Claim Development Procedures Medicare Summary Notice Medicare Remittance Advice and Claim Control Numbers Medicare Remit Easy Print (MREP) ANSI Codes
Appendix	Acronyms/Abbreviations DME MACs Jurisdiction A Contact Information Additional DME Contacts CMS Website Resources Contacting Noridian and Inquiries Telephone Inquiries Noridian Medicare Portal Written Inquiries Privacy Act of 1974 and HIPAA Privacy Rules Freedom of Information Act (FOIA)

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Last Updated May 31, 2017

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