Common Reasons for Denial

• Recertified or revised Certificate of Medical Necessity (CMN) or DME Information Form (DIF) for item was not submitted or not on file with Noridian or
• CMN is in denied status

Next Step

• If CMN is in denied status, work with Supplier Contact Center to determine what was wrong with CMN, once that is determined, appeal claim
• 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
• A self service reopening may be conducted if CMN or DIF is now on file with Noridian
• 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
• If an initial CMN/DIF is posted to Common Working File (CWF) under another jurisdiction, include a comment on claim narrative
• 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
• Ensure that recert or revised CMN or DIF is transmitted.
• 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 CMD/DIF may not have been received by Noridian with the claim.