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End User Manual for the Noridian Medicare Portal

Eligibility

View a beneficiary's Medicare eligibility: Part A, Part B, Managed Care Organization (MCO) and Health Maintenance Organization (HMO), Medicare Secondary Payer (MSP), Home Health, Hospice, End Stage Renal Disease (ESRD), and Preventive Services.

When entering information into the inquiry screens in the portal, copy and paste functionality may cause extra spaces to be entered. In this case, the portal will state the beneficiary information is invalid. Ensure no extra spaces are entered.

Inquiry

  • Choose the Tax Identification Number (TIN) or Social Security Number (SSN), National Provider Identifier (NPI) and Provider Transaction Access Number (PTAN) combination under Provider/Supplier Details.
  • Complete the mandatory fields (Health Insurance Claim Number (HICN) and Last Name) and enter the beneficiary's first name and/or date of birth. The name must be entered as it states on the beneficiary's Medicare card. Complete optional details to narrow the search.

If a specific date of service is in question, enter the date(s) in the From Date and To Date fields. Otherwise, the beneficiary's eligibility will display for the current date. Eligibility inquiries will only accept dates of service 12 months prior to the current date and up to four months in the future.

Eligibility Benefits Inquiry screen is displayed.

Response

The HIPAA Eligibility Transaction System (HETS) is considered the authoritative source for beneficiary Part A and B effective and termination, demographic, MCO and HMO, and ESRD data. For CMS purposes, authoritative source means the data originates here and is shared with other systems. View more information on HETS on the CMS website This link will take you to an external website.

Eligibility screen

Each tab provides specific information.

Field Name

Description

Eligibility

  • Part A and B effective and termination dates
  • Deductible remaining
  • Ineligible Period (Due to classified as unlawfully present, deported or incarcerated)
  • Beneficiary address
  • Occupational, physical, and speech therapy
  • Blood deductible

Managed Care Organization (MCO) and Health Maintenance Organization (HMO)

  • Insurer name
  • Policy number
  • Effective and termination dates
  • MCO Plan Type
  • MCO Bill Option Code
  • Address

Medicare Secondary Payer (MSP)

  • Insurer name
  • Policy number
  • Effective and termination dates
  • Insurer type
  • Address

Home Health Episode History (HHEH)

  • Payer name and ID
  • Provider number
  • Episode start and end date
  • Earliest and latest billing dates

Hospice

  • Episode effective and termination dates
  • Provider number

Hospital

  • Earliest and latest billing dates
  • Deductible remaining
  • Full days remaining
  • Lifetime reserve days remaining
  • Lifetime Psychiatric remaining and base days
  • Copayment days remaining
  • Copayment amount remaining

Skilled Nursing Facility (SNF)

  • Earliest and latest billing dates
  • Days remaining
  • Copayment days remaining
  • Copayment amount remaining

End Stage Renal Disease (ESRD)

  • Effective date
  • Benefit type

Preventive

  • Smoking cessation benefit information
  • Preventive services benefit information
  • HCPCS code/Description/next eligibility date

 

Preventive Service CPT / HCPCS

  • 77057
  • 80061
  • 82270-26
  • 82270-TC
  • 82465
  • 82947
  • 82950
  • 82951
  • 83718
  • 84478
  • G0102
  • G0101-26
  • G0101-TC
  • G0103-26
  • G0103-TC
  • G0104
  • G0105
  • G0106
  • G0117
  • G0118
  • G0120
  • G0121
  • G0123
  • G0143
  • G0144
  • G0145
  • G0147
  • G0148
  • G0202
  • G0328-26
  • G0328-TC
  • G0389
  • G0402
  • G0403
  • G0404-TC
  • G0405-26
  • G0438-26
  • G0439-26
  • G0444
  • G0445
  • G0446
  • G0447
  • P3000
  • Q0091-26
  • Q0091-TC 

Claim Status

View the status of claims, view Medical Review comments and Additional Documentation Requests (ADRs), if applicable, and initiate a reopening or redetermination on finalized claims.

When entering information into the inquiry screens, copy and paste functionality may cause extra spaces to be entered. In this case, the portal will state the beneficiary information is invalid. Ensure no extra spaces are entered.

Inquiry

  • Choose TIN or SSN, NPI and PTAN combination under Provider/Supplier Details
  • Complete mandatory fields in Beneficiary Details section. Complete optional fields to narrow search.
    • Entering a date of service is suggested to narrow the number of results.

Claim Status Inquiry screen is displayed.

Response

A listing of all claims that matched the Inquiry details will display. Select the "View Claim" link to receive additional claim information.

Claim Status Results screen is displayed.

Information received should match the Interactive Voice Response (IVR) system. Consult the Supplier Contact Center if information returned is not as expected. 

The Noridian Medicare Portal displays all diagnoses submitted on a claim and identify which diagnosis is indicated as the primary diagnosis per line item on a claim. 

Claim Status Response with Claim Diagnosis Code and Pointer Details

The following table provides the field name and the description of the field.

Field Name

Description

CCN (Claim Control Number)

  • Unique number assigned to claim at the time received by contractor
  • Used to track and monitor claim

Status

Status of claim, e.g., finalized or pending

Billed Amount

Total charges submitted

Finalized Date

Date when claim completed the adjudication process

Provider Paid Amount

Total amount paid to provider

Specialty

Specialty code

Total Deductible

Dollar amount applied to beneficiary's deductible

Receipt Date

Date claim was received

Beneficiary State

State beneficiary resides in according to Social Security

Crossover Indicator

  • "Y" indicates claim is a crossover claim
  • "N" indicates claim is not a crossover claim

Crossover claims are automatic electronic transfer of payment information on finalized claims to supplemental insurance companies and Medicaid that have signed agreements

Last Worked Date

Date the last time claim was examined

Check/EFT#

  • Number on the check issued for payment
  • If Electronic Funds Transfer (EFT) was used for payment, this field displays the trace number

Line

Service line number of the claim

From DOS

Beginning date of service (DOS) for the claim billing period

To DOS

End date of service for the claim billing period

HCPCS

Healthcare Common Procedure Coding System (HCPCS) codes

Modifier

Code that adds specification to HCPCS categorization

Units

Number of units billed on claim

POS

Place of Service (POS) code

Diagnosis Code

  • First code displayed is code describing principal diagnosis
  • Remaining codes correspond to additional conditions that coexisted

Billed Amount

Dollar amount billed for line item

Allowed Amount

Total amount allowed for service line

Provider Paid

Amount provider/supplier was paid for this line item

Reason Code

National administrative code set that identifies reasons for any differences or adjustments between original provider charge and payer's payment 

 

Claim Processing Comments

The portal offers access to view claim processing comments if a claim had been selected for prepayment review in which Noridian requested documentation prior to making a claim decision. In the event a claim was not suspended during processing, this option will not be presented.

First, perform a Claim Status Inquiry as described above.

If the claim had a history of being reviewed for additional documentation, the portal will offer a "Noridian Comments" link in the claim header.

Claim Status Results with Noridian Comments button is displayed.

After selecting this link, the claim processing comments will be retrieved and presented.

Noridian Comments screen is displayed.

Protected Health Information (PHI) is not included within the Noridian examiner's comments.

There may be a rare occasion where a claim's history does not have comments associated with it; however, the portal might offer the "Noridian Comments" feature. In this situation, a message will be displayed indicating comments are not available. 

Additional Documentation Request

If an ADR was sent to the supplier and the claim is pending, suppliers may view the letter and submit supporting documentation.

Claim status details

Suppliers may view a list of the most recent 100 claims an ADR was sent on and the most recent 100 claims a response has been received on.

Inquiry

  • Select Claim Status from main menu and then Additional Documentation Request tab

Additional Documentation Reqeust tab is displayed.

  • Choose TIN or SSN, NPI and PTAN combination under Provider/Supplier Details
  • Choose one of below. Each option will provide different results
    • "Request Sent" - View up to 100 claims in which Noridian mailed an ADR letter to the supplier but response has not yet been received.
    • "Response Received/Processing" – View up to 100 claims that have had an ADR letter issued by Noridian and supplier has responded in a timely manner and is pending processing.

Additional Documentation Inquiry screen is displayed.

Response

Request Sent:

The results for the Request Sent option provide the following:

Claim Number

  • HICN
  • First Name
  • Last Name
  • Date of Service
  • Date Requested
  • Date Due
  • Option to View Request
  • Option to Upload/View Response

To add a document, select the Add a Document button.

  • Title document with a recognizable name
  • Browse computer to locate document
  • Select Upload button
    • The document will now be displayed in Documentation Attached To This Claim section. To view attachments, select Document ID number

Responses Received/Processing:

The results for the Responses Received/Processing option provide the following:

  • Claim Number
  • HICN

Additional Documentation Results screen is displayed.

Notes:

  • There will be a delay from the date a supplier responds via postal mail, Electronic Submission of Medical Documentation (esMD), fax and the portal to the day the claim may display in the ADR Response Received/Processing status.
  • Only ADR letters sent after January 1, 2015, are available.
  • When selecting Add Document, this initiates a documentation response to the ADR letter. Suppliers should not select this feature unless they have the supporting documents available to begin the upload process. 

Self-Service Reopenings

Suppliers may create a self-service reopening for the following:

  • Add or remove diagnosis codes
  • Add or replace modifiers RR and MS, remove modifier RA
  • Reprocess a claim

Go to the Self Service Reopenings section of the User Manual to view further instructions.

Financial Information

View pending and finalized check information issued to an NPI/PTAN combination.

Inquiry

  • Select Financial from top navigation or home page and then Payment Results tab
  • Choose TIN or SSN, NPI and PTAN combination under Provider/Supplier Details

Financial Inquiry screen is displayed.

Response

The portal provides the most recent 50 checks and the following:

  • Number of pending claims and dollar amount
  • Number of claims approved-to-pay and dollar amount

Financial Results screen is displayed.

Overpayments

Inquiry

  • Select Financial from top navigation or home page and then Overpayment Results tab
  • Choose TIN or SSN, NPI and PTAN combination under Provider/Supplier Details
  • Enter 14-digit Financial Control Number (FCN) that is provided on remittance advice and overpayment letter

Overpayment Results inquiry screen is displayed.

Response

The overpayment results page provides a summary of the supplier, patient account number, date of service and the overpayment amount.

Below that, the portal displays a list of the claims that have caused the overpayment. The information includes:

  • Indicator for Offset = O, Refund = R, or Interest = I
  • Beneficiary name
  • Patient Account Number (if the supplier entered this on their claim)
  • Date of Service
  • Date the claim was applied to the overpayment
  • CCN
  • Supplier Check Number
  • Amount paid or withheld
  • Accrued Interest

Overpayment Results screen is displayed.

Appeals Status Inquiry

Noridian processes reopening and redetermination requests within 60 days of receipt.

Inquiry

To check the status of a reopening or redetermination, select the TIN or SSN, NPI and PTAN it was submitted under and select one of the following options:

  • Option 1 – View Last 100 Appeals
  • Option 2 –  Search Existing Appeals
    • HICN
    • Appeal Status (Pending, Finalized, Additional Documentation Needed)
    • Confirmation Number

Response

The results will display the confirmation number, claim number, HICN, status and date submitted. To view more information on the request select View Appeal. A list of the submitted documentation displays. To view the document, select View Document. If additional documentation is needed, select "Add a Document."

The decision letter from Appeals is available to view when the request is finalized. Letters are only available for partially favorable and denied appeals. Suppliers are notified of favorable decisions through the remittance advice.

Begin New Appeal

A new appeal can also be submitted by performing a claim status inquiry and following the same steps.

Inquiry

  • Choose TIN or SSN, NPI and PTAN combination under Provider/Supplier Details
  • Complete mandatory fields in Beneficiary Details section. Complete optional fields to narrow search

Appeals Status Inquiry screen is displayed.

Response

The results will display based on the criteria entered. To begin the appeal choose View Claim.

Additional claim details are provided. To begin the appeal choose the Redetermination/Reopening Submission button.

Reopening or Redetermination Request Form

The Reopening or Redetermination Request form displays. User sessions time out after 30 minutes of inactivity. Ensure all information is gathered prior to beginning the request. There are four steps to complete an appeal.

Redetermination/Reopening Details

The claim details are provided and the following questions are asked:

  • Type of Request – Redetermination or Reopening
  • Will a review of this claim cause an overpayment?
    • If answered yes, users are prompted to request a recoupment. The appeal process will not continue.

Reopening or Redetermination?

  • Is this request the result of an overpayment?
    • If answered yes, users are asked who initiated the overpayment (Benefit Integrity, Comprehensive Error Rate Testing (CERT), Medical Review, Office of Inspector General (OIG), Recovery Auditor, Supplemental Medical Review Contractor (SMRC) or Zone Program Integrity Contractor (ZPIC)/Program Safeguard Contractor (PSC)). The Accounts Receivable (AR) Number is then required. The AR number is found on the overpayment letter from Noridian.

Submission Details

  • The contact person (portal user submitting the request) information is also displayed. Address information is requested on an appeal, however, this information is not required.

Contact Person and Provider Address

  • Next, suppliers will enter the claim details and an explanation as to why the appeal is being submitted and any other information is needed for the Noridian examiner.

Details and Explanation

  • In the Claim Status Line Details section, users must check the box next to the line item the reopening or redetermination is being requested on. Note: Checking all will initiate an appeal on all lines regardless of whether they are paid or denied. This may result in a loss of further appeal rights.

Claim Status Line Details

  • Select Next.

Electronic Signature

Users must read the attestation. If agreed, the user must type their name under "Signatory Name" and check the box next to "I have read the attestation and agree." Select the Submit button.

Electronic Signature

Add Documents

To attach documentation, select the "Add Document" button. Title the document so it is recognizable when reviewing the submission and browse to locate it. Numerous documents may be added during this step. If more than one file is needed to be uploaded, select the "Add Document" button again to add another file. Once this is completed, select the Next button. If a document needs to be removed, select the Delete link in the last column.

Add Documents

Confirmation

Step 4 displays a successful upload message and show the appeal information below. To add additional documents, choose the "Add Document" button on the bottom of the screen.

In the event a supplier has submitted a reopening/redetermination and he/she wants to delete/dismiss, a document explaining the dismissal/deletion needs to be created on the company letterhead and must contain an original, "pen and ink" true signature. This dismissal request needs to be uploaded as an attachment to the existing appeal. 

Appeal Confirmation Screen is displayed.

Claim-Specific Remittance Advices

View and/or print a remittance advice information for a single claim.

Inquiry

  • Select Remittance Advices from home page
  • Choose TIN or SSN, NPI and PTAN combination under Provider/Supplier Details
  • Enter number of claim
    • DME suppliers must also enter beneficiary's HICN

Claim Specfic Remit Inquiry screen is displayed.

Response

A copy of the claim-specific remittance advice displays. To print the claim-specific remittance advice, select "Printable Version" in the upper left corner. (The information that appears on this screen will vary depending on the claim). Definitions of remark and reason codes are provided at the bottom of the screen.

DME Claim Specific Remit results are displayed.

Same or Similar

Inquiry

  • Select Same or Similar from home page
  • Choose TIN or SSN, NPI and PTAN combination under Provider/Supplier Details
  • Complete mandatory fields in Beneficiary Details section

Same or Similar Inquiry screen is displayed.

  • Under Same or Similar Details, select 1 of 2 Options
    • Option 1: Enter the date of service and a HCPCS code tracked for same or similar. The HCPCS code must be listed on the Same or Similar Reference Chart. Same or similar is not available for HCPCS codes beginning with G, J, L, Q or V.

Same or Similar Option One is displayed.

  • Option 2: Search for the most recent paid claim for HCPCS codes beginning with A, L or V. These codes are supplies, prosthetics and vision.

Same or Similar Option Two is displayed.

Response – Option 1: Same or Similar

The portal searches claims back five years on most items; eight years for enteral nutrition pumps. For oxygen, the portal searches lifetime.

Same or Similar Example
HCPCS code: E0184
Date of service entered: 01/01/2015
NMP searches: 01/01/2010 – 01/01/2015

The following information is provided:

  • Submitted HCPCS code
  • Approved HCPCS code
  • Initial date on file
  • Recertification date (if applicable)
  • Last day item billed
  • Name of supplier who provided the item
  • Supplier's phone number

Same or Similar Option One Results are displayed.

Possible Error Messages

  • The message "After searching the beneficiary files, Noridian does not show any results for the criteria inquired on" displays when there are no same or similar HCPCS codes on the beneficiary's file.
  • If the beneficiary information entered does not match our system, a message stating "The beneficiary Medicare number, name or date of birth does not match our records." 

Response – Option 2: Supplies, Orthotics, Prosthetics and Vision

Frequency Example
HCPCS Code: A4369
The portal searches for the most recent paid claim for this HCPCS code.

The following information is provided:

  • HCPCS
  • Date of Service
  • Number of Units
  • Name of supplier who provided the item
  • Supplier's phone number

Same or Similar Option 2 Results are displayed.

If no matching HCPCS are on file the message returned will state, "After searching the beneficiary files, Noridian does not show any results for the criteria inquired on. This response is the same information that our Noridian DME Customer Service Representatives have access to."

PMD Prior Authorization Request Status

DME suppliers may check the status of Power Mobility Device (PMD) Prior Authorization Request (PAR) status.

Inquiry

  • Select Prior Authorizations from home page
  • Choose TIN or SSN, NPI and PTAN combination under Provider/Supplier Details
  • Enter HICN, first and last name
  • Enter HCPCS code on PMD PAR

Prior Authorization Inquiry screen is displayed.

For information and a list of applicable HCPCS codes, see the Prior Authorization webpage.

Response

The portal provides the following information:

  • Unique Tracking Number
  • Receipt date
  • Decision (Pending, Denied, Affirmative)

Only requests received on/after September 1, 2012, are displayed. 

Prior Authorization Results screen is displayed.

NMP Browser Compatibility

The Noridian Medicare Portal is accessible from several different web browsers; however, only certain browsers are supported. View the chart below to determine the browser requirements for using the portal. Using older browsers, non-compatible browsers, or disabling browser features such as JavaScript, may reduce functionality in website. To download the latest version of one of these browsers, us the links below.

Supported Browsers

Suppliers can check their browser version by going to the Help menu and selecting "About...." A screen will appear showing which browser and version is being used.

The Noridian Medicare Portal is best viewed when the display resolution is set to 1024 x 768 or above. If the settings are below 1024 x 768, additional scroll bars will be encountered.

Support Contact Information

  • Phone: 866-419-9458
  • Have the following information available: User name, company name, TIN

Other Contacts

Suppliers and beneficiaries may need to call other contractors in order to update or inquire on the information provided in the eligibility function of the portal:

  • Beneficiary Call Center - 1-800-MEDICARE (1-800-633-4227)
  • Coordination of Benefits - 1-855-798-2627
  • Home Health - To update information, beneficiary must contact Home Health Agency
  • Social Security Administration (SSA) - To update information, beneficiary must contact SSA at 1-800-772-1213

Security Awareness Training and Recertification

  • Security Awareness Training - Security Awareness Training occurs upon the first login and will occur on a yearly basis in conjunction with the recertification. The process will initiate 45 days prior to the last day of the month in which the users account was initially setup. This training must be completed within the 45 day period in order to continue using the portal. If this training is not completed within the timeframe, the user's account will be disabled and the user must contact Noridian Medicare Portal Support in order to unlock it. Upon logging in again, the user will be prompted to complete the training. If the training is not completed within 90 days, the user's account will be deleted and the user must re-register.
  • Recertification - Portal users will be prompted to recertify accounts on a yearly basis. This recertification demonstrates the Noridian Medicare Portal account is being used by the appropriate person. The process will initiate 45 days prior to the last day of the month in which the users account was initially setup. The recertification must be completed within the 45 day period in order to continue using the portal. If the account is not recertified within the timeframe, the user's account will be disabled and the user must contact Noridian Medicare Portal Support in order to unlock it. Upon logging in again, the user will be prompted to recertify the account. If it is not recertified within 90 days, the user's account will be deleted and the user must re-register.

Last Updated May 22, 2017