Common Reasons for Denial

• A recent break in medical need
• 13/15 months have been paid
• Same and Similar equipment on file

Next Step

• If a break in need, resubmit claim with a narrative (narrative on claim line "BIN")
• Request an extension of an existing CMN to allow payment if 13/15 payments have not been paid by adding either on the claim narrative of the claim or through telephone reopenings
• A Redetermination request may be submitted with all relevant supporting documentation. Noridian encourages Redeterminations/Appeals be submitted using the Noridian Medicare Portal. Review applicable Local Coverage Determination (LCD), LCD Policy Article, and Documentation Checklists prior to submitting request

How to Avoid Future Denials

Refer to applicable Local Coverage Determination (LCD), LCD Policy Article to verify a CMN/DIF is required

• If a break in medical need, submit claim with a narrative to extend the CMN (narrative on claim line "BIN")
• The Noridian Medicare Portal can be accessed under Same or Similar to verify number of  rental payments or similar equipment on file or call the Noridian Interactive Voice Response (IVR) System @ 877-320-0390 for that information