Article Detail - JD DME

Not sure what this denial means and how to resolve it? Follow the “Next Steps” on the Denial Code Resolution Tool. Some of the common reasons for this denial are:

• Item billed may require a specific diagnosis or modifier code based on related LCD
  • Suppliers may do a self-service reopening in the Noridian Medicare Portal to adjust diagnosis based on medical records available to supplier
• A development letter requesting additional documentation to support service billed was not received within provided timeline
• Item billed does not meet medical necessity
  • 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-related Policy Article, and Documentation Checklists prior to submitting request
  • Noridian encourages Redeterminations be submitted using the Noridian Medicare Portal