End User Manual for the Noridian Medicare Portal

MBI Lookup Tool

The Medicare Beneficiary Identifier (MBI) Lookup Tool is an option for providers/suppliers to use if they are not able to obtain the MBI from the patient. For complete instructions, view the MBI Lookup Tool page.

Eligibility

View a beneficiary's Medicare eligibility: Part A, Part B, Managed Care Organization (MCO) and Health Maintenance Organization (HMO), Medicare Secondary Payer (MSP), Home Health, Hospice, End Stage Renal Disease (ESRD), Preventive Services and Medicare Diabetes Prevention Program (MDPP).

When entering information into the inquiry screens in the portal, copy and paste functionality may cause extra spaces to be entered. In this case, the portal will state the beneficiary information is invalid. Ensure no extra spaces are entered.

Inquiry

  • Choose the Tax Identification Number (TIN) or Social Security Number (SSN), National Provider Identifier (NPI) and Provider Transaction Access Number (PTAN) combination under Provider/Supplier Details.
    • Note: DME Vendor End Users are required to enter a Trading Partner ID and Vendor TPID. 
  • Complete the mandatory fields (Medicare Number and Last Name) and enter the beneficiary's first name and/or date of birth. The name must be entered as it states on the beneficiary's Medicare card. Complete optional details to narrow the search.

You can either enter a custom date range to inquire on, or select todays date, or select the option to search 12 months in the past and 4 months into the future. HETS does allow transactions 12 months in the past and four months into the future so Noridian does suggest entering that date span. That'll give all of the results for the past year and the next few months instead of only the current date.

This image shows the Eligiblity Benefits inquiry screen on the Noridian Medicare Portal.

Response

The HIPAA Eligibility Transaction System (HETS) is considered the authoritative source for beneficiary Part A and B effective and termination, demographic, MCO and HMO, and ESRD data. For CMS purposes, authoritative source means the data originates here and is shared with other systems. View more information on HETS on the CMS website.

If the beneficiary is enrolled as a Qualified Medicare Beneficiary (QMB), a green banner will display letting the user know that the beneficiary is a QMB enrollee.

This image shows the QMB verbiage in the Noridian Medicare Portal.

Each tab provides specific information.

Field Name Description
Eligibility
  • Part A and B effective and termination dates
  • Deductible remaining
  • Ineligible Period (Due to classified as unlawfully present, deported or incarcerated)
  • Beneficiary address
  • Occupational, physical, and speech therapy
  • Blood deductible
  • Part D Enrollment Data (if applicable)
    • Contract Name
    • Contract Number
    • Contract Phone Number
    • Contract Website
    • Contract Address
    • Enrollment and Disenrollment Date
    • Part D Prescription Drug Coverage
Managed Care Organization (MCO) and Health Maintenance Organization (HMO)
  • Insurer name
  • Policy number
  • Effective and termination dates
  • MCO Plan Type
  • MCO Bill Option Code
  • Address
Medicare Secondary Payer (MSP)
  • Insurer name
  • Policy number
  • Effective and termination dates
  • Insurer type
  • Address
Home Health Episode History (HHEH)
  • Payer name and ID
  • Provider number
  • Episode start and end date
  • Earliest and latest billing dates
Hospice
Hospital
  • Earliest and latest billing dates
  • Deductible remaining
  • Full days remaining
  • Lifetime reserve days remaining
  • Lifetime Psychiatric remaining and base days
  • Copayment days remaining
  • Copayment amount remaining
Skilled Nursing Facility (SNF)
  • Earliest and latest billing dates
  • Days remaining
  • Copayment days remaining
  • Copayment amount remaining
End Stage Renal Disease (ESRD)
  • Effective date
  • Benefit type
Preventive
  • Smoking cessation benefit information
  • Preventive services benefit information
  • HCPCS code/Description/next eligibility date
  • Pulmonary benefit information
  • Cardiac and Intensive Cardiac Rehabilitation Services
Medicare Diabetes Prevention Program (MDPP)
  • MDPP Active Period
  • MDPP Inactive Period
  • MDPP Deductible Period
  • MDPP Coinsurance Period

 

Preventive Service CPT / HCPCS:

77057, 80061, 81528, 82270-26, 82270-TC, 82465, 82947, 82950, 82951, 83718, 84478, G0102, G0101-26, G0101-TC, G0103-26, G0103-TC, G0104, G0105, G0106, G0117, G0118, G0120, G0121, G0123, G0143, G0144, G0145, G0147, G0148, G0202, G0297, G0328-26, G0328-TC, G0389, G0402, G0403, G0404-TC, G0405-26, G0438-26, G0439-26, G0443, G0444, G0445, G0446, G0447, G0472, G0473, G0475, P3000, Q0091-26, Q0091-TC 

Claim Status

View the status of claims, view Medical Review comments and Additional Documentation Requests (ADRs), if applicable, and initiate a reopening or redetermination on finalized claims.

When entering information into the inquiry screens, copy and paste functionality may cause extra spaces to be entered. In this case, the portal will state the beneficiary information is invalid. Ensure no extra spaces are entered.

Inquiry

  • Choose TIN or SSN, NPI and PTAN combination under Provider/Supplier Details
    • Note: DME Vendor End Users are required to enter a Trading Partner ID and Vendor TPID. 

  • Complete mandatory fields in Beneficiary Details section. Complete optional fields to narrow search.
    • Entering a date of service is suggested to narrow the number of results.

This image shows the Claim Status Inquiry screen on the Noridian Medicare Portal.

Response

A listing of all claims that matched the Inquiry details will display. Select the "View Claim" link to receive additional claim information.

Information received should match the Interactive Voice Response (IVR) system. Consult the Supplier Contact Center if information returned is not as expected.

The Noridian Medicare Portal displays all diagnoses submitted on a claim and identify which diagnosis is indicated as the primary diagnosis per line item on a claim.

Claim Status Response with Claim Diagnosis Code and Pointer Details

The following table provides the field name and the description of the field.

Field Name Description
CCN (Claim Control Number)
  • Unique number assigned to claim at the time received by contractor
  • Used to track and monitor claim
Status Status of claim, e.g., finalized or pending
Billed Amount Total charges submitted
Finalized Date Date when claim completed the adjudication process
Provider Paid Amount Total amount paid to provider
Specialty Specialty code
Total Deductible Dollar amount applied to beneficiary's deductible
Receipt Date Date claim was received
Beneficiary State State beneficiary resides in according to Social Security
Crossover Indicator
  • "Y" indicates claim is a crossover claim
  • "N" indicates claim is not a crossover claim
Crossover claims are automatic electronic transfer of payment information on finalized claims to supplemental insurance companies and Medicaid that have signed agreements
Last Worked Date Date the last time claim was examined
Check/EFT#
  • Number on the check issued for payment
  • If Electronic Funds Transfer (EFT) was used for payment, this field displays the trace number
Line Service line number of the claim
From DOS Beginning date of service (DOS) for the claim billing period
To DOS End date of service for the claim billing period
HCPCS Healthcare Common Procedure Coding System (HCPCS) codes
Modifier Code that adds specification to HCPCS categorization
Units Number of units billed on claim
POS Place of Service (POS) code
Diagnosis Code
  • First code displayed is code describing principal diagnosis
  • Remaining codes correspond to additional conditions that coexisted
Billed Amount Dollar amount billed for line item
Allowed Amount Total amount allowed for service line
Provider Paid Amount provider/supplier was paid for this line item
Reason Code National administrative code set that identifies reasons for any differences or adjustments between original provider charge and payer's payment

 

Claim Processing Comments

The portal offers access to view claim processing comments if a claim had been selected for prepayment review in which Noridian requested documentation prior to making a claim decision. In the event a claim was not suspended during processing, this option will not be presented.

First, perform a Claim Status Inquiry as described above.

If the claim had a history of being reviewed for additional documentation, the portal will offer a "Noridian Comments" link in the claim header.

This image shows where the Noridian Comments link is on the Noridian Medicare Portal.

After selecting this link, the claim processing comments will be retrieved and presented.

Noridian Comments screen is displayed.

Protected Health Information (PHI) is not included within the Noridian examiner's comments.

There may be a rare occasion where a claim's history does not have comments associated with it; however, the portal might offer the "Noridian Comments" feature. In this situation, a message will be displayed indicating comments are not available.

Expanded Denial Details

NMP provides expanded denial details within Claim Status Results. This will allow access to important denial details without a separate eligibility inquiry.

Go to the Expanded Denial Details section of the User manual to view further instructions.

Additional Documentation Request Submission and Status

If an ADR was sent to the supplier and the claim is pending, suppliers may view the letter and submit supporting documentation.

Go to the Additional Documentation Request Submission and Status section of the User Manual to view further instructions.

Self-Service Reopenings

Suppliers may create a self-service reopening for the following:

  • Add or remove diagnosis codes
  • Add or replace modifiers RR and MS, remove modifier RA
  • Reprocess a claim

Go to the Self Service Reopenings section of the User Manual to view further instructions.

Financial Information

View pending and finalized check information issued to an NPI/PTAN combination.

Inquiry

  • Select Financial from top navigation or home page and then Payment Results tab
  • Choose TIN or SSN, NPI and PTAN combination under Provider/Supplier Details
    • Note: DME Vendor End Users are required to enter a Trading Partner ID and Vendor TPID. 

Financial Inquiry screen is displayed.

Response

The portal provides the most recent 50 checks and the following:

  • Number of pending claims and dollar amount
  • Number of claims approved-to-pay and dollar amount

Financial Results screen is displayed.

Overpayments

Inquiry

  • Select Financial from top navigation or home page and then Overpayment Results tab
  • Choose TIN or SSN, NPI and PTAN combination under Provider/Supplier Details
    • Note: DME Vendor End Users are required to enter a Trading Partner ID and Vendor TPID. 
  • Enter 14-digit Financial Control Number (FCN) that is provided on remittance advice and overpayment letter

Overpayment Results inquiry screen is displayed.

Response

The overpayment results page provides a summary of the supplier, patient account number, date of service and the overpayment amount.

Below that, the portal displays a list of the claims that have caused the overpayment. The information includes:

  • Indicator for Offset = O, Refund = R, or Interest = I
  • Beneficiary name
  • Patient Account Number (if the supplier entered this on their claim)
  • Date of Service
  • Date the claim was applied to the overpayment
  • CCN
  • Supplier Check Number
  • Amount paid or withheld
  • Accrued Interest

Overpayment Results screen is displayed.

Appeals Status Inquiry

Noridian processes reopening and redetermination requests within 60 days of receipt.

Inquiry

To check the status of a reopening or redetermination, select the TIN or SSN, NPI and PTAN it was submitted under and select one of the following options:

Note: DME Vendor End Users are required to enter a Trading Partner ID and Vendor TPID. 

  • Option 1 - View Last 100 Appeals
  • Option 2 - Search Existing Appeals
    • Medicare ID
    • Appeal Status (Pending, Finalized, Additional Documentation Needed)
    • Confirmation Number

Response

The results will display the confirmation number, claim number, Medicare ID, status and date submitted. To view more information on the request select View Appeal. A list of the submitted documentation displays. To view the document, select View Document. If additional documentation is needed, select "Add a Document."

The decision letter from Appeals is available to view when the request is finalized. Letters are only available for partially favorable and denied appeals. Suppliers are notified of favorable decisions through the remittance advice.

Begin New Appeal

A new appeal can also be submitted by performing a claim status inquiry and following the same steps.

Inquiry

  • Choose TIN or SSN, NPI and PTAN combination under Provider/Supplier Details
    • Note: DME Vendor End Users are required to enter a Trading Partner ID and Vendor TPID.

  • Complete mandatory fields in Beneficiary Details section. Complete optional fields to narrow search

This image shows the Appeals Status Inquiry screen on the Noridian Medicare Portal.

Response

The results will display based on the criteria entered. To begin the appeal choose View Claim.

Additional claim details are provided. To begin the appeal choose the Redetermination/Reopening Submission button.

Reopening or Redetermination Request Form

The Reopening or Redetermination Request form displays. User sessions time out after 30 minutes of inactivity. Ensure all information is gathered prior to beginning the request. There are four steps to complete an appeal.

Redetermination/Reopening Details

The claim details are provided and the following questions are asked:

  • Type of Request – Redetermination or Reopening
  • Will a review of this claim cause an overpayment?
    • If answered yes, users are prompted to request a recoupment. The appeal process will not continue.

Reopening or Redetermination?

  • Is this request the result of an overpayment?
    • If answered yes, users are asked who initiated the overpayment (Benefit Integrity, Comprehensive Error Rate Testing (CERT), Medical Review, Office of Inspector General (OIG), Recovery Auditor, Supplemental Medical Review Contractor (SMRC) or Zone Program Integrity Contractor (ZPIC)/Program Safeguard Contractor (PSC)). The Accounts Receivable (AR) Number is then required. The AR number is found on the overpayment letter from Noridian.

Submission Details

  • The contact person (portal user submitting the request) information is also displayed. Address information is requested on an appeal, however, this information is not required.

Contact Person and Provider Address

  • Next, suppliers will enter the claim details and an explanation as to why the appeal is being submitted and any other information is needed for the Noridian examiner.

Details and Explanation

  • In the Claim Status Line Details section, users must check the box next to the line item the reopening or redetermination is being requested on. Note: Checking all will initiate an appeal on all lines regardless of whether they are paid or denied. This may result in a loss of further appeal rights.

Claim Status Line Details

  • Select Next.

Electronic Signature

Users must read the attestation. If agreed, the user must type their name under "Signatory Name" and check the box next to "I have read the attestation and agree." Select the Submit button.

Electronic Signature

Add Documents

To attach documentation, select the "Add Document" button. Title the document so it is recognizable when reviewing the submission and browse to locate it. Numerous documents may be added during this step. If more than one file is needed to be uploaded, select the "Add Document" button again to add another file. The file size for each upload is 70 MB. File types accepted include: .doc, .docx, .xls, .xlsx, .pdf, .bmp, .ppt, .pptx, .gif, .jpeg, .jpg, .png, rtf, .tif, .tiff, .txt, .xml, .dbf and .xxA1.

Note: Condensing all documentation submitted in one file will allow for easier processing by the Noridian Medical Review staff.

Once this is completed, select the Next button. If a document needs to be removed, select the Delete link in the last column.

Add Documents

Confirmation

Step 4 displays a successful upload message and show the appeal information below. To add additional documents, choose the "Add Document" button on the bottom of the screen.

In the event a supplier has submitted a reopening/redetermination and he/she wants to delete/dismiss, a document explaining the dismissal/deletion needs to be created on the company letterhead and must contain an original, "pen and ink" true signature. This dismissal request needs to be uploaded as an attachment to the existing appeal.

Claim-Specific Remittance Advices

View and/or print a remittance advice information for a single claim.

Inquiry

  • Select Remittance Advices from home page
  • Choose TIN or SSN, NPI and PTAN combination under Provider/Supplier Details
    • Note: DME Vendor End Users are required to enter a Trading Partner ID and Vendor TPID. 
  • Enter number of claim
    • DME suppliers must also enter beneficiary's Medicare Number

This image shows the Claim Specific Remittance Advice Inqiury screen on the Noridian Medicare Portal.

Response

A copy of the claim-specific remittance advice displays. To print the claim-specific remittance advice, select "Printable Version" in the upper left corner. (The information that appears on this screen will vary depending on the claim). Definitions of remark and reason codes are provided at the bottom of the screen.

DME Claim Specific Remit results are displayed.

Same or Similar

Inquiry

  • Select Same or Similar from home page
  • Choose TIN or SSN, NPI and PTAN combination under Provider/Supplier Details
    • Note: DME Vendor End Users are required to enter a Trading Partner ID and Vendor TPID. 
  • Complete mandatory fields in Beneficiary Details section

This image shows the Same or Similar Inquiry screen on the Noridian Medicare Portal.

  • Under Same or Similar Details, select 1 of 2 Options
    • Option 1: Enter the date of service and a HCPCS code tracked for same or similar. The HCPCS code must be listed on the Same or Similar Reference Chart. Same or similar is not available for HCPCS codes beginning with G, J, L, Q or V.

Same or Similar Option One is displayed.

  • Option 2: Search for all paid date of services for a range of HCPCS codes beginning with A, L or V. These codes are supplies, prosthetics and vision.

This shows Option 2 for the Same or Similar Inquiry

Response - Option 1: Same or Similar

The portal searches claims back five years on most items; eight years for enteral nutrition pumps. For oxygen, the portal searches lifetime.

Same or Similar Example
HCPCS code: E0184
Date of service entered: 01/01/2015
NMP searches: 01/01/2010 – 01/01/2015

The following information is provided:

  • Submitted HCPCS code
  • Approved HCPCS code
  • Initial date on file
  • Recertification date (if applicable)
  • Last day item billed
  • Name of supplier who provided the item
  • Supplier's phone number

Possible Error Messages

  • The message "After searching the beneficiary files, Noridian does not show any results for the criteria inquired on" displays when there are no same or similar HCPCS codes on the beneficiary's file.
  • If the beneficiary information entered does not match our system, a message stating "The beneficiary Medicare number, name or date of birth does not match our records."

Response - Option 2: Supplies, Orthotics, Prosthetics and Vision

Frequency Example
From HCPCS Code: A5510
To HCPCS Code: A5540
The following information is provided:

  • HCPCS
  • Date of Service
  • Number of Units
  • Name of supplier who provided the item
  • Supplier's phone number

If no matching HCPCS are on file the message returned will state, "After searching the beneficiary files, Noridian does not show any results for the criteria inquired on. This response is the same information that our Noridian DME Customer Service Representatives have access to."

PMD Prior Authorization Request Status

DME suppliers may check the status of Power Mobility Device (PMD) Prior Authorization Request (PAR) status.

Inquiry

  • Select Prior Authorizations from home page
  • Choose TIN or SSN, NPI and PTAN combination under Provider/Supplier Details
    • Note: DME Vendor End Users are required to enter a Trading Partner ID and Vendor TPID. 
  • Enter Medicare ID, first and last name
  • Enter HCPCS code on PMD PAR

This image shows the Prior Authorization Inquiry screen on the Noridian Medicare Portal.

For information and a list of applicable HCPCS codes, see the Prior Authorization webpage.

Response

The portal provides the following information:

  • Unique Tracking Number
  • Receipt date
  • Decision (Pending, Denied, Affirmative)

Only requests received on/after September 1, 2012, are displayed.

This image shows the Prior Authorization Results screen.

Send Us A Message

Users may send Noridian a secure message regarding claims that have been reviewed by CERT or the Noridian Medical Review teams.

Go to the Send Us A Message section of the User Manual to view further instructions.

NMP Browser Compatibility

The Noridian Medicare Portal is accessible from several different web browsers; however, only certain browsers are supported. View the chart below to determine the browser requirements for using the portal. Using older browsers, non-compatible browsers, or disabling browser features such as JavaScript, may reduce functionality in website. To download the latest version of one of these browsers, us the links below.

Supported Browsers

Suppliers can check their browser version by going to the Help menu and selecting "About...." A screen will appear showing which browser and version is being used.

The Noridian Medicare Portal is best viewed when the display resolution is set to 1024 x 768 or above. If the settings are below 1024 x 768, additional scroll bars will be encountered.

Support Contact Information

For Contact Information, see the Contact Us page of the Noridian website.

Other Contacts

Suppliers and beneficiaries may need to call other contractors in order to update or inquire on the information provided in the eligibility function of the portal:

  • Beneficiary Call Center - 1-800-MEDICARE (1-800-633-4227)
  • Coordination of Benefits - 1-855-798-2627
  • Home Health - To update information, beneficiary must contact Home Health Agency
  • Social Security Administration (SSA) - To update information, beneficiary must contact SSA at 1-800-772-1213

Security Awareness Training and Recertification

  • Security Awareness Training - Security Awareness Training occurs upon the first login and will occur on a yearly basis in conjunction with the recertification. The process will initiate 45 days prior to the last day of the month in which the users account was initially setup. This training must be completed within the 45 day period in order to continue using the portal. If this training is not completed within the timeframe, the user's account will be disabled and the user must contact Noridian Medicare Portal Support in order to unlock it. Upon logging in again, the user will be prompted to complete the training. If the training is not completed within 90 days, the user's account will be deleted and the user must re-register.
  • Recertification - Portal users will be prompted to recertify accounts on a yearly basis. This recertification demonstrates the Noridian Medicare Portal account is being used by the appropriate person. The process will initiate 45 days prior to the last day of the month in which the users account was initially setup. The recertification must be completed within the 45 day period in order to continue using the portal. If the account is not recertified within the timeframe, the user's account will be disabled and the user must contact Noridian Medicare Portal Support in order to unlock it. Upon logging in again, the user will be prompted to recertify the account. If it is not recertified within 90 days, the user's account will be deleted and the user must re-register.

 

Last Updated Oct 15, 2018