Common Reasons for Denial

• An initial Certificate of Medical Necessity (CMN) or DME Information Form (DIF) was not submitted with claim or on file with Noridian or
• CMN is in denied status

Next Possible Steps

• If CMN is in denied status, work with Supplier Contact Center to determine what was wrong with CMN, once that is determined, appeal claim
• A self-service reopening in the Noridian Medicare Portal may be conducted if CMN or DIF is now on file with Noridian.
• The Noridian Medicare Portal can be accessed under Same or Similar to verify if the CMN or DIF is on file or call the Noridian Interactive Voice Response (IVR) System for CMN or DIF information
• If CMN or DIF is not on file, resubmit claim with CMN/DIF
• Did your CMN/DIF get accepted when billed through the electronic transmission? If the front end acknowledgement reports from the electronic transmission with CEDI are not worked by supplier staff or clearinghouse, the CMN/DIF may not have been received by Noridian with the claim. Appeal claim with all medical documentation, including valid CMN
• A Redetermination request may be submitted with all relevant supporting documentation. Noridian encourages Redeterminations/Appeals be submitted using the Noridian Medicare Portal. Review applicable Local Coverage Determination (LCD), LCD Policy Article, and Documentation Checklists prior to submitting request

How to Avoid Future Denials

• To verify a CMN or DIF is required, required for dates of service prior to January 1, 2023, refer to applicable Local Coverage Determination (LCD), LCD Policy Article
• For proper claims processing, attach initial CMN or DIF to claim, required for dates of service prior to January 1, 2023
  • Supplier must submit initial CMN or DIF for item billed
• If an initial CMN or DIF is posted to Common Working File (CWF) under another jurisdiction, include a comment on claim narrative
• Ensure all the front end acknowledgement reports from the electronic transmission with CEDI are worked by supplier staff or clearinghouse, to ensure the CMN/DIF is put on file