Supplier Manual - JD DME

• Introduction
• Medicare Card
• Noridian's Role as a DME MAC
• Railroad Retirement Board (RRB)
• United Mine Workers Association (UMWA)
• What is Medicare?

To enroll as a Medicare DME supplier, there are requirements that must be met. View the National Provider Enrollment (NPE) West website to read articles, access learning & educational information, view resources and learn about Supplier enrollment related processes, rules, and regulations. The website provides guidance on the steps necessary to becoming a DMEPOS supplier.

See the Noridian webpage for Enrollment information including enrollment applications and electronic funds transfers.

• Advance Beneficiary Notice of Noncoverage (ABN)
• Back-Up Equipment
• Beneficiaries Entering Medicare
• Beneficiary Authorization
• Comprehensive Error Rate Testing (CERT)
• Continued Use and Continued Medical Need
• Documentation Requirements
• Documenting Repair Claims
• Medical Record Information
• Medicare HMO Beneficiaries Transferring to Fee-For-Service Medicare
• Miscellaneous Documentation Issues (Delivery Fees)
• Pick-up Slips
• Proof of Delivery
• Refill Documentation
• Requirement of New Orders
• Same/Similar Equipment and ABNs
• Standard Written Order
• Starting a New Capped Rental Period
• Supplier Documentation
• Who can Order? (including PECOS Edits, Nurse Practitioners or Clinical Nurse Specialist Rules Concerning Orders and CMNs, and Physician Assistant Rules Concerning Orders and CMNs

• Capped Rental Items
• Customized Items
• DMEPOS and Inpatient Stays
• Inexpensive or Other Routinely Purchased DME
• Items Requiring Frequent and Substantial Servicing
• Other Prosthetic and Orthotic Devices
• Oxygen and Oxygen Equipment
• Parenteral/Enteral Nutrition Therapy
• Payment Categories
• Repairs, Maintenance and Replacement

• Assignment Agreement
• Beneficiary Signature Requirements
• Claim Submission
• Clean Claims - Payment/Interest
• CMS-1500 Claim Form
• Consolidated Billing
• Definition of a Claim for Payment
• Hospice
• Incomplete or Invalid Claims Processing Terminology
• Mandatory Claim Filing
• Medically Unlikely Edits
• Medicare Advantage Plans
• Participation Program
• Place of Service
• Time Limit for Filing Claims
• Upgrades

• Crossover Claims

• Common Electronic Data Interchange (CEDI) Electronic Claim Submission
• CEDI Help Desk

• Advance Determination of Medicare Coverage (ADMC)
• Citations for DMEPOS Benefit Categories
• DMEPOS Benefit Categories
• LCD Reconsideration Process
• Local Coverage Determination and Policy Article Overview
• National Coverage Determinations
• Required Prior Authorization Programs

• Assignment of Specialty Codes
• Claims
• Enrollment
• Facility Requirements
• Guidelines
• Indian Health Services

• Coordination of Benefits
• Medicare Secondary Payer (MSP)
• MSP Claim Filing Tips
• MSP Payment Calculation

• Drug Pricing
• Fee Schedules
• Pricing

• Administrative Law Judge
• Appeals
• Appeals Council
• Federal Court Review
• Parties to Appeals
• Reconsiderations
• Redeterminations
• Reopenings

• Abuse
• Fraud
• Penalties
• Reporting

• Extended Repayment Schedule
• Immediate Recoupment Process / Immediate Offset Requests
• Overpayment Rebuttals
• Overpayments and Refunds
• Recovery Auditor Overpayments
• Refund of Excess Recoupments
• Voluntary Refunds

• Modifiers
• Pricing, Data Analysis and Coding

• Additional Documentation Request (ADR)
• Claim Adjustment Group Codes
• Medicare Remit Easy Print (MREP)
• Medicare Remittance Advice and Claim Control Numbers
• Medicare Summary Notice

• Acronyms/Abbreviations
• Additional DME Contacts
• CMS Website Resources
• Contacting Noridian and Inquiries
• DME MACs
• Freedom of Information Act (FOIA)
• Noridian Medicare Portal
• Privacy Act of 1974 and HIPAA Privacy Rules
• Telephone Inquiries
• Written Inquiries