Common Reasons for Denial

• Non-covered charge(s). Item does not meet the criteria for the category under which it was billed.

Next Step

• If billed incorrectly (such as inadvertently omitting a required modifier), request a reopening. Utilize the Noridian Modifier Lookup Tool to ensure proper modifiers are included on claim
• If is for the KX, GA, GZ, or GY modifiers, 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

• Review applicable Local Coverage Determination (LCD), LCD Policy Article documentation requirements for coverage and use of modifiers. Utilize the Noridian Modifier Lookup Tool to ensure proper modifiers are included on claim, prior to billing.