Common Reasons for Denial

• Item has met maximum limit for this time period. Payment already made for same/similar procedure within set time frame.

Next Step

• Review claim submitted for frequency limits or same or similar items listed in LCD and Policy Article, through Same or Similar option 2 and either adjust amounts because of supplier liable or appeal claim with documentation to support medical need.

• 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

• Ensure that item is reasonable and necessary and that policy limitations have not already been met. The Noridian Medicare Portal can be accessed under Same or Similar to verify same or similar items or call the Noridian Interactive Voice Response (IVR) System for Same or Similar