Article Detail - JD DME
Patient Eligibility Unavailable on Interactive Voice Response (IVR)
In accordance with CMS Change Request (CR) 13754, to protect beneficiaries from possible fraud, the Centers for Medicare and Medicaid Services (CMS) has required all Medicare Administrative Contractors (MACs) to disable eligibility information from their IVR systems by March 2025.
Once disabled, CMS will require all providers and suppliers to check beneficiary eligibility through one of the following self-service tools:
- MAC secure online provider portal
- Billing agencies, clearinghouses, or software vendors
- Health Insurance Portability and Accountability Act (HIPAA) Eligibility Transaction System (HETS)
Providers will not be able to obtain patient eligibility information by calling Noridian. Neither Noridian’s IVR nor representatives will be able to disclose patient eligibility over the phone. This includes beneficiary eligibility that was obtained under Option 1, Eligibility, such as:
- Part A and Part B entitlement dates
- Current/prior year Part B deductible information
- Current/prior year physical therapy and occupational therapy limit amount used
- ESRD coverage dates, dialysis and/or transplant date
- HH+H name, NPI, address and effective/termination dates
- Certain Preventive care details
To assist providers with this change, Noridian will be offering webinars about navigating Noridian’s MAC portal, the Noridian Medicare Portal. Providers may register for these webinars at Noridian’s Schedule of Events.
Providers may also view Noridian’s Noridian Medicare Portal User Guide. Noridian encourages all impacted providers to ensure their staff are aware of this change.
