Additional Documentation Request (ADR) Timeline Calculator - Calculate date Noridian must receive requested documentation

Administrative Law Judge (ALJ) Calculator - Calculate ALJ request submission deadline

Advance Beneficiary Notice of Noncoverage (ABN) Tutorial - Hover over form fields to identify details required for each

Appeals Decision Tree - Used to determine if a claim can be appealed

Capped Rental Monthly Payment Calculator - Find correct payment based on month and HCPCS of rented product

CERT Quick Look Documentation Tool - View guide of common Comprehensive Error Rate Testing (CERT) policies under review and documentation that is typically required for policy criteria to be met

CMS-1500 Claim Form Tutorial - Hover over form fields to identify details required for each

Claim Submission Timelines Calculator - Calculate claim submission deadline

Clinician Resource Letters - Provide these letters to physicians to help them include and/or gather appropriate documentation

Consolidated Billing/SNF/Home Health/Hospice Lookup -Tool is intended to assist suppliers/providers with determining if a specific HCPCS is considered under consolidated billing for SNF, Home Health (HH) and Hospice

Continuous Passive Motion (CPM) Device Billing Span Dates Calculator - Calculator will assist suppliers determine how many days a device can be billed to the DME MAC after surgery is performed

Denial Code Resolution - View most common claim submission errors/descriptions, solutions, and ways to prevent them in the future

Documentation Checklists - View checklists to help identify records not routinely submitted by providers but must be available upon request

ESRD 30-Month Coordination Period Calculator - Calculate 30 month coordination period prior to Medicare becoming primary insurance

Enteral Nutrition Calculator - Determine correct number of units to submit Enteral and Parenteral Nutrition claims

Extended Repayment Schedule (ERS) Decision Tree - Provides a listing of the documentation needed with an ERS application depending on the length of the loan being requested.

External Infusion Pump (EIP) Drug Calculators - Determine appropriate units of service to bill on a claim for drugs used with external infusion pump (EIP)

Fee Schedule Lookup Tool - Find DMEPOS, Drug or PEN fees

Former CBA and Rural Zip Code Lookup Tool - Determine if a zip code was included in a Competitive Bid Area (CBA), which CBA, and if it is included in the CMS Rural Zip code file.

IVR Conversion Tool - Determine touch-tone number sequence to enter in IVR

Medically Unlikely Edit (MUE) Lookup Tool - Helps to determine the maximum units of service that a provider would report under most circumstances for a single beneficiary on a single date of service

Medicare Secondary Payer (MSP) Decision Tree - Used to determine whether Medicare is primary or secondary

Medicare Secondary Payer (MSP) Payment Calculator - Enter specific amounts from primary insurance company's Explanation of Benefits in addition to their billed amount to determine Medicare's payment (line-level, not full claim billed amount)

Nebulizer Drug Calculators - Enter strength of drug, size of vial dispensed (if applicable) and frequency medication is taken to determine maximum number of units that can be billed in a 31 or 90 day period

Noridian Medicare Portal (NMP) - Access eligibility, claim status, same/similar, overpayments, Reopening/Redetermination submission and status inquiry, power mobility device prior authorization request status, and claim-specific Remittance Advices (RAs)

Overpayment Decision Tree - Used to determine options for refunding Medicare overpayments

Oxygen Modifier Decision Tree - Determine the appropriate modifier to use for oxygen.

Pre-Claim Comparison Tool - View key differences between the Pre-Claim programs: Condition of Payment Prior Authorization (COPPA) Program and Advance Determination of Medicare Coverage (ADMC)

Prior Authorization Look Up Tool - Determines which HCPCS codes require a Prior Authorization

Reconsideration Calculator - Calculate Reconsideration request submission deadline

Recovery Auditor Contractor Calculator - Calculate time frames for Recovery Auditor activities

Redetermination Calculator - Calculate Redetermination request submission deadline

Remittance Advice (RA) Tutorial - Hover over RA items to identify details of each field

Reopening Timeliness Calculator - Calculate Reopening request submission deadline


Last Updated Jun 07, 2019