Expanded Denial Details

NMP provides expanded claim denial details for the below claim denials. This will allow access to important denial details without a separate eligibility inquiry.

If an error message stating "Your inquiry cannot be performed at this time" occurs, the patients file could have been updated after the claim has processed. If further assistance is needed, contact the Provider Contact Center.

You will first perform a Claim Status Inquiry and view the desired claim.

In the Related Inquiries section, a link for MSP, HMO, Eligibility, Date of Death, Hospice or Home Health Denial Details will display.

This image displays the Claim Status Details results with the Related Inquiries section.

MSP Denial Details

This image displays the MSP Denial Details link in the Related Inquiries section of Claim Status Results.

MSP Denial Details will display the following:

  • Insurer Type
  • Insurers Name
  • Address
  • Policy Number
  • Effective and Term Date

In the Resources section the Phone Number for any BCRC updates, IOM references and references to the Noridian MSP topic page are provided.

This image displays the MSP Denial Details.

HMO Denial Details

This image displays the HMO Denial Details link in the Related Inquiries section of Claim Status Results.

HMO Denial Details will display the following:

  • Start and End Date
  • Plan ID
  • Plan Name and Address

To update the status of the HMO, the beneficiary or legal representative must contact the plan.

This image displays the HMO Denial Details.

Eligibility Denial Details

This image displays the Eligibility Denial Details link in the Related Inquiries section of Claim Status Results.

Eligibility Denial Details will display the following:

  • Part A Entitlement and Termination Dates
  • Part B Entitlement and Termination Dates

To update their entitlement, the beneficiary or legal representative must contact the Social Security Administration (SSA).

This image displays the Eligibility Denial Details.

Date of Death Denial Details

This image displays the Date of Death Denial Details link in the Related Inquiries section of Claim Status Results.

Date of Death Denial Details will display the following:

  • Date of Death on File in the Social Security Administration (SSA) Record

To update the record, the beneficiary or legal representative must contact the Social Security Administration (SSA).

In the resources section we provide a CMS link as a reference.

This image displays the Date of Death Denial Details.

Hospice Denial Details

This image displays the Hospice Denial Details link in the Related Inquiries section of Claim Status Results.

Hospice Denial Details will display the following:

  • Start and End Date
  • Provider NPI

Links to the NPI Registry and CMS IOM references are provided in the Resources section.This image displays the Hospice Denial Details.

Home Health Denial Details

This image displays the Home Health Denial Details link in the Related Inquiries section of the Claim Status Results.

The Home Health Denial Details will display the following:

  • From and Thru Dates of the Home Health Plan on File
  • Provider NPI

In the resources section we provide a link to the NPI Registry website and CMS IOM references in the resources section, as well as a CMS link to Home Health Information.

This image displays the Home Health Denial Details.

Overlap Denial Details

This image displays the Overlap Denial Details link under Related Inquiries

The Overlap Denial Details will display the following:

  • From and Thru Dates of the Overlap
  • Provider NPI

In the resources section we provide a link to the NPI Registry website.

This image displays the Overlap Denial Details.

Patient Status Denial Details

This image displays the Patient Status Denial Details link in the Related Inquiries section

The Patient Status Denial Details will display the following:

  • From Date
  • Facility Type

This image displays the Patient Status Denial Details

Skilled Nursing Facility/Inpatient Denial Details

This image shows the SNF/Inpatient Denial Details link.

The SNF/Inpatient Denial Details will display the following:

  • From and Thru Date
  • Provider NPI
  • Additional Resources

This image shows the Claim Denial Details for the SNF/Inpatient denials.

Alien and Incarcerated Denial Details

This image shows the Eligibility Denial Details link.

The Alien and Incarcerated Denial Details will display the following:

  • Start and End Date
  • Additional Resources

This image shows the Claim Denial details for incarcerated or alien denials.

End Stage Renal Disease Denial Details

This image shows the ESRD/Dialysis denial details link.

The ESRD/Dialysis Denial Details will display the following:

  • From and Thru Date
  • Provider NPI
  • Additional Resources

This image shows the Claim Denial Details for the ESRD/Dialysis denials.

 

Last Updated Nov 08, 2018