Why Is My Claim Denied?

Your facility will receive a Remittance Advice (RA) that provides a short descriptor of the denial reason.  We also provide a narrative detail reason on the reviewed claim in the Medicare claim system.  You can access these comments via DDE or Noridian Medicare Portal.

Providers without access to DDE can contact the Provider Contract Center (PCC) with any questions on how to register and gain access to these online tools.

Accessing Medical Review Determinations in DDE:

  1. At the Main Menu Screen enter "01" and press "Enter" to access the Inquiries sub-menu.
  2. Enter "12" and press "Enter" to access the claims screen.
  3. Enter the beneficiary's Health Insurance Claim (HIC) number and claim dates of service. "Press Enter."
  4. To view claim, place cursor in the "SEL" field on the first line of the claim. Enter "S" to select claim and press "Enter."
  5. Find remarks on claim page 4.

Accessing Medical Review Determination in Noridian Portal:  

The portal offers access to view claim processing comments if a claim had been selected for prepayment review in which Noridian requested documentation prior to making a claim decision. In the event a claim was not suspended during processing, this option will not be presented.

Noridian Medicare Portal End User Manual

Noridian Medicare Portal Registration Guide

  1. Perform a Claim Status Inquiry as described in the portal user manual.
     
  2. If the claim had a history of being reviewed for additional documentation, the portal will offer a "Noridian Comments" link in the claim header.
    Claim Status Details with the Related Claim Details button is displayed.
     
  3. After selecting this link, the claim processing comments will be retrieved and presented at the bottom of the Claim Status details.
    Claim Processing Comments are displayed.


 

Last Updated Apr 21, 2017