Additional Self-Service Requirements Effective November 6, 2023

In accordance with Internet Only Manual (IOM), Publication 100-09, CMS requires the use of self-service tools to verify all claim status and patient eligibility information. The use of these tools prevents unnecessary denials for providers and helps ensure proper payment of claims. To assist providers with these requirements, Noridian has created education about the following self-service tools.

To further assist providers, Noridian has also published weekly updates and hosted webinars. Examples of information available on these tools include:

  • Claim Status information for all processed and pending claims (E.g., claim number, receipt date, and patient responsibility for denied and paid claims)
  • Appeal rights, status, and letters
  • Patient’s insurance and eligibility information
  • Duplicate and overlapping claim information
  • Provider’s enrollment information
  • Local Coverage Determination (LCD) and National Coverage Determination (NCD) numbers.

To remain in compliance with CMS guidelines, effective November 6, 2023, Noridian representatives assist with a single claim denial that can be resolved via the use of a self-service tool. (e.g., the patient having another insurance to Medicare) as a courtesy. This will help providers to better understand what specific claim adjustment reason codes (CARC) and Remittance advice remark codes (RARC) mean and how to resolve those claims going forward.

Noridian requests this information be shared with all provider staff to ensure they abide by Medicare’s requirements.



Last Updated Nov 01 , 2023