Eligibility Details Expanded in Portal - Now Including QMB Details

Qualified Medicare Beneficiaries (QMB)

Effective November 19, 2017, the Noridian Medicare Portal (NMP) offers Qualified Medicare Beneficiary (QMB) information on an eligibility inquiry. Low- income beneficiaries receive assistance with their Medicare premiums and cost-sharing through the QMB program. NMP will now display if the beneficiary is enrolled in this program.

This shows the Eligibility results with the QMB banner.

If a beneficiary is a QMB, additional benefit information will be displayed on a green line in the Eligibility response.

Date of Service Options for Eligibility Inquiry

Users now have three options to choose from for Date of Service under "Optional Details" when performing an Eligibility inquiry. The inquiry will default to a date range of 12 months if no other option is selected. The current date or a specific date range may be chosen to narrow down the results.

This shows the added Optional Details in the Eligibility Inquiry.

These updates are an addition to the previously published enhancements below.

Effective November 5, 2017, the Noridian Medicare Portal (NMP) offers additional beneficiary eligibility information including hospital spell dates, Part D enrollment, preventive service expanded for colorectal, alcohol and rehabilitation services, and Hospice occurrence counts. Noridian recommends entering ‘From' and ‘To Dates' when performing an Eligibility inquiry to receive the most accurate entitlement information.

Below is a brief description and screen shot to show where these enhancements can be seen. 

Hospital Benefit Information

Hospital Benefits will offer the current years Part A Base Deductible, Part A Spell days remaining and the Earliest and Latest Billing Dates for Hospital spells. 

This shows the Hospital information in the Eligibility results.

Part D Enrollment Data

The following items for Part D Enrollment are available under the Eligibility tab of the response. If the beneficiary is not enrolled in Part D, these fields will remain blank.

  • Contract Name
  • Contract Number
  • Contract Phone Number
  • Contract Website
  • Enrollment and Disenrollment Date
  • Part D Enrollment Prescription Drug Coverage
  • Contract Address

This shows the Part D Enrollment information in Eligibility results.

Preventive Services

The following Preventive Services CPT/HCPCS codes will be listed on the Preventive Services tab and provide the date the beneficiary is next eligible for that service.

  • 81528
  • G0297
  • G0442
  • G0443
  • G0472
  • G0473
  • G0475

The Preventive Services tab now offers Pulmonary, Cardiac and Intensive Cardiac Rehabilitation Services. The following information is available:

  • Professional Sessions Remaining
  • Technical Sessions Remaining
  • Professional Sessions Used
  • Technical Sessions Used

This shows the Preventive information in Eligibility results.

 

Hospice Benefits

The Hospice Benefit has also been expanded to provide the Occurrence Count of each Hospice episode.

This shows the Hospice information in Eligibility results.

The CMS HIPAA Eligibility Transaction System (HETS) is the authoritative source for all eligibility inquires performed in the portal (and IVR). Noridian hopes you find these enhancements valuable. We encourage you to complete the website satisfaction survey each time it is presented to you so we may continue to improve our portal services.

 

Last Updated Feb 27, 2019