Receiving Denials For Beneficiary With An HMO, Reason Code 109, Remark Code N418

A dedicated tab can be found in the Noridian Medicare Portal (NMP) eligibility tab for Health Maintenance Organization (HMO) and Managed Care Organization (MCO) information to ensure billing to the correct payor the first time and avoiding rework.

Obtain the following information regarding beneficiaries by selecting the Eligibility tab on the NMP.

  • Insurer name
  • Policy number
  • Effective and termination dates
  • Plan type
  • Bill option code
  • Plan address
  • Plan phone number

To resolve denials suppliers would send the claim to the HMO plan listed on the NMP under Expanded Denial Details. Please utilize the Denial Code Resolution webpage on the Noridian Medicare website for more information.

            Last Updated Thu, 11 Aug 2022 18:20:39 +0000