Provider Outreach and Education (POE) Advisory Group Minutes - June 11, 2019

Roll Call

Noridian Attendees

Claire Anderson, Elizabeth Barton, Kimberly Behrens, Tammy Ewers, Carynne Godfrey, Annessa Schjeldrup, Beth Sandeen, Julie Schroeder, Tana Williams

POEAG Member Attendance

Wendy Alfaro, Cheryl Bradley, Mitchel Kaye, Greg Labow, Susan LaPadula, Rick Lash, Dawn Silva

POEAG Mission and Goals

During each meeting, the Mission and Goals are reviewed.

Prior Meeting Minutes

The March 12, 2019 meeting minutes were distributed to POEAG members and published to the website April 5, 2019.

Prior Suggestions and Recommendations

The POEAG meeting recommendations and/or suggestions from the prior event with updates are reflected below.

Suggestion Date Description Resolution
Email SNF PART A Payment Model See CMS website for additional information: CMS SNF PDMP and CR11152
3/12/19 Will the Noridian Medicare Portal (NMP) offer beneficiary's Hospice or HMO information? Noridian shared Hospice and HMO information is available in eligibility and the Claim Status Expanded Denial Details results. We are interested to hear from our members on the expanded resources offered within NMP.
3/12/19 Will the NMP offer anything that will help the provider identify who to contact from the other facility when a claim overlap situation occurs? Historically, providers had been unable to share the confidential information. Noridian is excited for the new portal functionality. As part of the NMP Claim Status ‘expanded denial details' feature, when a claim denies due to an overlap situation, we publish the NPI, discharge status, and other details with a link for the NPI database to gain specific contact information. The eligibility information was also improved and may be used prior to claim submission to prevent the overlap billing too. Users who had used this NMP feature complimented the service during the meeting. Expanded Denial Details


New Agenda Items

Prior to the meeting, Noridian solicited agenda topics from members and evaluated significant program changes to discuss.

  1. New Medicare Card / Medicare Beneficiary Identifier (MBI) Updates: Now that CMS has completed the beneficiary mailings of the new insurance card, Noridian wants to share that we are less than 30 weeks away from the end of the transition period to obtain the new MBI number. We want to remind providers of the importance of switching to the new MBI number. As of January 1, 2020, Noridian will no longer be able to accept the Health Insurance Claim Number (HICN).
    • Additional resources available when the Beneficiary is unable to provide a copy of their new insurance card.
      • MBI look-up tool is available via NMP
      • Remittance advice (RA) will also provide new MBI when a valid HICN is submitted
    • Provider Outreach and Education team is working on data analysis information on percentage of MBI usage and reaching out to Providers with high percentages of claims not adapting new MBI transition
    • Monthly webinars for MBI information are available, register via our website
  2. CMS Medicare Learning Network (MLN) Matters Special Edition (SE)19007 - Address Verification Update: Part A Provider Bases Billing (PBB) Facilities Practice Address Verification Activation of Systematic Validation Edits for OPPS Providers with Multiple Service Locations: This conveys the activation of systematic validation edits to enforce the requirements in the CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 1, Section 170, which describes Payment Bases for Institutional Claims. These requirements are not new requirements. CMS discussed these requirements in Change Request (CR)9613 and CR9907, both of which were effective on January 1, 2017.
    • What can providers do?
      • Verify claim submission
      • Verify PECOS enrollment address
      • Attend upcoming DDE training, as CMS is adding a new option 1D for Provider Practice Address Query
        • Watch our site to sign up for training
      • See Provider Based Facilities webpage for more about provider-based facilities
      • SE19007        
  3. Ambulance Return Trip to Beneficiary's Home: Attention all skilled nursing facility (SNF) employees, registered nurses (RNs), dialysis centers, discharge planners, social services, physicians, hospitals, ambulance companies, etc. In most cases, Medicare does not cover ambulance trips when ordered by facilities or providers to return the beneficiary to their home (SNF, assisted living, residence, etc.). An ambulance transport must meet the medical necessity "if other means of transportation would endanger the beneficiary's health, whether or not it's available."  The transport becomes the beneficiary's financial burden. Per the CMS IOM, Publication 100-02, Chapter 10, Section 10.2.1, a 911 emergency call alone does not establish medical necessity.

    Many times, the SNF is responsible, under Consolidated Billing, for the transport. Other modes of transportation are to be used. Example: wheelchair van, cabulance, stretcher van, litter van, taxi, gurney van, transportation by a friend, neighbor or family member etc.

    These are non-covered services. To learn more, visit the Ambulance webpage.
  4. Self Service Education Opportunities: NMP Education
    • Upcoming Webinar: Completing an Appeal through the NMP - June 19, 2019
      • CR11042, IOM Publication 100-04, Chapter 29 - Appeals of Claims Decisions – Revisions incorporates the following updates:
        • Policy on use of electronic signatures
        • Timing of signatures on transfer of appeal rights and appointment of representative forms
        • Tolling an adjudication timeframe when trying to cure a defective appointment form
        • Limiting scope of redetermination review in certain instances
        • Application of good cause for late filing involving beneficiary accessibility
        • Application of good cause where there is a declared disaster
  5. Provider Enrollment: We have two new enrollment focused Education Representatives available to help our provider community. Any inquires that need Provider Enrollments attention, send to

Upcoming Events

Providers can view trainings and seminars available by visiting the "Education and Outreach / Schedule of Events" section of our website.

New POEAG Suggestions and Recommendations

During each meeting, all POEAG members are asked to provide suggestions on ways to increase education, improve training methods, or elaborate on topics discussed during the meeting.

  1. A provider addressed the concerns of the transition to HETS away from CWF, some discussion on what people are used to doing beyond eligibility, claim correction, etc. Providers are trying to figure out the timing. When is HIQA going away from DDE? Is there a schedule of functionality decommissioning?
  2. A provider addressed the address verification update on which Providers does it affect? Provider Based Billing Facilities (PBB) are the Providers affected.
  3. A provider addressed a question regarding the legal input to change Medicare Secondary Payer (MSP) information what does Benefits Coordination & Recovery Center (BCRC) need? 
    • Noridian will reach out to the BCRC
  4. POEAG members shared insight regarding the high number of California HMO claim denials.  Patients present their Medicare card and do not realize they have HMO. The RPM, a practice management system used by providers, has verification built in and shares the HMO carrier. Often beneficiaries disenroll retroactively; snapshot of eligibility in CA.
    • Noridian will continue to promote the use of NMP for each patient encounter and remind providers that NMP provides HMO information.

Upcoming Meeting

Scheduled Meetings for 2019

  • September 10, 2019 1-2 p.m. PT
  • December 10, 2019 1-2 p.m. PT

Thank you for attending today's meeting, we look forward to working with all of you again.


Last Updated Jun 26, 2019