Common Reasons for Denial

• Prescription is not on file or is incomplete or invalid

Next Step

• Did your CMN/DIF get accepted when billed through the electronic transmission? If the 5010A1 CEDI front end errors from the electronic transmission with CEDI are not worked by supplier staff or the clearinghouse, the CMN/DIF may not have been received by Noridian with the claim.
• Ensure the prescription is on file. This can be reviewed in the Noridian Medicare Portal under Same or Similar.
  • If not on file, resubmit claim with CMN/DIF.
• A written reopening may be submitted to load a new CMN. This can be accomplished through the appeals function using the Noridian Medicare Portal.
• A Redeterminations/Appeals request may be submitted with all relevant supporting documentation for DIF issues using the Noridian Medicare Portal.

How to Avoid Future Denials

• Ensure all CMNs and DIFs are accepted with the claim through the electronic transmission and resolve all errors as quickly as possible.

Check the Noridian Medicare Portal if you have questions as to what type of CMN/DIF is on file, (initial, recert, revised) and if it is valid.