Prior to providing a new item, and to gain the necessary information required (has there been a change in beneficiary's medical condition that supports need for a different type of similar item or if it has been lost, stolen, or irreparably damaged) to determine whether an Advance Beneficiary Notice of Noncoverage (ABN) should be obtained or not, it is best to:

• Verify that a beneficiary has/has not had a same or similar item
  • If he/she has not, bill claim without ABN (no ABN is necessary)
  • If he/she has, determine if item has reached its specific reasonable useful lifetime (RUL)
    • If it has, bill claim without ABN (no ABN is necessary)
    • If it has not, obtain an ABN and bill claim with applicable modifier

Verification options include:

1. Ask beneficiary
2. Check via Noridian Interactive Voice Response (IVR)
3. Access such information within Noridian Medicare Portal (NMP)

If there is any reason to believe that a beneficiary may have obtained a same or similar item outside of Jurisdiction A, check with the other jurisdictions (B, C, and D) as well.

• Same or Similar Denials
• Same or Similar and Advance Beneficiary Notice of Noncoverage (ABN) Documentation
• Reasonable Useful Lifetime Clarification
• Reasonable Useful Lifetime and Duplicate Items - Billing Reminder

The list is NOT all inclusive and that while every effort is made to keep it current, there may be relationships that might trigger a denial that are not listed.