Tools

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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

Claim Denial Rate Calculator - Use this calculator to determine denial percentages for all supplier claims, including individual denial rate for Target Probe and Educate (TPE) review, denial rates for individual policy categories or determine overall Medicare dollar percentages denied

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

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

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

Surgical Dressings Exudate and Wound Depth Lookup Tool - Determine type of dressings covered based on exudate and wound depth information

Surgical Dressings HCPCS Lookup Tool - Search by HCPCS to find dressing type, wound depth, exudate and usual dressing change information

Surgical Dressings Type Lookup Tool - Determine wound depth, exudate and usual dressing change by selecting a dressing type

 

Last Updated Oct 03, 2019