NMP and/or IVR Required Use for Claim Status - Effective February 18, 2019

Effective February 18, 2019, suppliers will be required to use the Noridian Medicare Portal (NMP) and/or the Interactive Voice Response (IVR) self-service tools to access the below claims related information. Until then, Customer Service Representatives (CSRs) will educate callers on these tools.

NMP

Claim Status Results

  • Claim Control Number (including Internal Control Number (ICN) or Document Control Number (DCN))
  • Date of service (DOS)
  • Claim status (pending or processed)
  • Total billed amount
  • Finalized date
  • Electronic Funds Transfer (EFT)/check number
  • Total paid amount

In "View Claim Details" column of the Claim Status Results table, select "View Claim" to see the below claim related information.

  • DOS
  • Allowed amount
  • Claim finalization date
  • Referring provider National Provider Identifier (NPI)
  • Rendering NPI and Provider Transaction Access Number (PTAN)
  • Billing NPI and PTAN
  • Total deductible
  • Place of service (POS)
  • Claim receipt date
  • Claim processed as primary or Medicare Secondary Payer (MSP)
  • MSP type (if applicable)
  • If claim crossed over (Y or N)
  • Tax identification number
  • Diagnosis codes submitted
  • Details of individual line items
    • DOS
    • Procedure codes and modifiers
    • Units
    • Diagnosis pointer
    • Individual billed, allowed, and paid amounts
    • Remittance Advice (RA) reason codes and descriptions

IVR

  • Number of claims on file for DOS
  • Claim status (pending or processed)
  • Total billed amount
  • Total allowed amount
  • Total amount applied to deductible
  • Total paid amount
  • Finalized date
  • Check number

State "Claim Details" for more details

  • ICN/DCN
  • If claim is primary or MSP
  • Number of line items
  • Paid line item details
    • DOS
    • Billed amount
    • Allowed amount
    • Procedure code and modifier
    • Primary diagnosis code
  • Denied line item details
    • DOS
    • Denial description from RA
    • Billed amount

NOTE: Per the CMS Internet Only Manual (IOM), Publication 100-09, Medicare Administrative Contractor (MAC) Beneficiary and Provider Communications Manual, Chapter 6, Section 50.1, "Providers shall be required to use IVRs to access claim status and beneficiary eligibility information. CSRs shall refer providers back to the IVR if they have questions about claims status or eligibility that can be handled by the IVR ... Each MAC has the discretion to also require that providers use the Internet-based provider portal for claim status and eligibility inquiries if the portal has these functionalities."

This process change will allow Noridian to meet CMS requirements and our CSRs to assist callers with more complex inquiries which cannot be answered through these self-service tools. See our Contact Center webpage for further information.

Last Updated Feb 04, 2019