Provider Customer Service FAQs - JE Part A
Provider Customer Service Frequently Asked Questions (FAQs)
Questions commonly asked of the Noridian Contact Center and Written Inquiry staff are provided.
Q1. Who can I contact to get my Direct Data Entry (DDE) password reset?
A1. Providers may contact our User Security staff to have their DDE passwords reset. Additional information regarding DDE is available on this website.
Q2. What self service tools are available for providers?
A2. Noridian offers a variety of timeliness calculators, hover and view tutorials, presentation-style tutorials, interactive forms, and other tools to assist providers. The most used tools are:
- Direct Data Entry (DDE) allows providers access to data in the Fiscal Intermediary Shared System (FISS) system. Using DDE provider may obtain beneficiary eligibility through Health Insurance Query Access (HIQA); claim status and review; check information; and a variety of other functions.
- The Noridian Medicare Portal offers authorized providers/users access to obtain Medicare eligibility, claim status, and single-claim Remittance Advices inquiries over the Internet.
- The Interactive Voice Response (IVR) system is available for all providers to access Patient Eligibility, Claim Status, Checks, Remittance Advice, Patient Status, and Preventive Services.
Q3. How can Medicare Secondary Payer (MSP) claims be submitted to Noridian?
A3. Beginning January 1, 2016, MSP claims may be submitted through DDE, electronically through direct submission from your facility to Electronic Data Interchange Support Services (EDISS), or through a Billing Service or Clearinghouse. See EDI Support Services Billing Medicare Secondary Payer (MSP) Claims Electronically for Instructions on billing MSP claims electronically (batch submission).
If a MSP claim needs to be adjusted corrected or cancelled, this can also be completed electronically or through DDE.
Refer to CMS Change Request (CR) 8486 to review new instructions for submitting MSP claims through DDE.
If you do not have the ability to submit electronic claims, providers may submit these claims hardcopy. Request for an adjustment may be sent along with an Explanation of Benefits (EOB) to the Noridian MSP Department using the MSP Form [PDF].
Q4. Where are the Claim Adjustment Reason Codes (CARC) located?
A4. The CARC list is available at: https://nex12.org/index.php/codes/11-claim-adjustment-reason-codes.
Q5. How can I verify if a patient went to another facility upon discharge?
A5. Providers needing to verify if a patient was admitted inpatient to another facility upon discharge, may obtain this information through the IVR. Once applicable information is given to the IVR, the IVR will provide the starting date and type of facility of the following claim. Published instructions on using the IVR are available on this website.
Q6.Am I required to use the revised Advance Beneficiary Notice of Noncoverage (ABN) Form (Form CMS-R-131)?
A6. Yes, providers must use the latest version of the ABN. Noridian provides a tutorial, instructions and additional information regarding ABN usage on this website.
Q7. Why does the IVR ask for the NPI, PTAN, and TIN before transferring me to a representative?
A7. In order to check provider or beneficiary specific information, a provider must first be authenticated using the NPI, PTAN and TIN. When callers give this information to the IVR, the representative that gets the call is able to see the authenticated information. When the provider is authenticated by the IVR, the caller and representative can discuss issues immediately without going through the provider authentication process. This is required due to CMS Internet Only Manual (IOM) Publication 100-09, Chapter 6.
Q8. When a provider has a National Provider Identifier (NPI) for a facility, how can they find out which facility it belongs to without calling the Provider Contact Center?
A8. Providers can look up the NPI for a facility on the National Plan and Provider Enumeration System (NPPES) website . Once on the site, click on NPI Registry, and then click on Organizational Provider. This will bring you to the NPI Registry Search page where you can enter the facility's NPI and the security image and click Search. In most cases, the search results will display the facility's name, address, phone number, and fax number.
Q9. What happens if someone ignores a demand letter request from Noridian regarding a Part A Overpayment?
A9. If there is no response after 30 days, one 30-day period of interest is accrued and a second demand letter is sent out. If there is no response to the second demand letter, a third demand letter will be sent with current interest calculations. The third demand letter will also include the intent to refer debt to the Department of Treasury's Debt Collection Center for cross servicing and offset of Federal payments and certain eligible State payments information. If there is no response on day 61, the matter will be referred to the Department of the Treasury Debt Collection Center. The provider will also remain on payment withholding at the contractor level. The Debt Collection Center will use various tools to collect the debt, including offset, demand letters, phone calls, referral to a private collection agency and referral to the Department of the Justice for litigation. Other collection tools available, which may be used, include Federal salary offset, administrative wage garnishment and the offset of income tax returns through the Internal Revenue Service. If the debt is discharged, it may be reported to the IRS as potential taxable income. During the collection process, interest will continue to accrue on the debt and the provider will remain legally responsible for any amount not satisfied through the collection efforts. More information is available on this website.
Q10. When a Customer Service Representative (CSR) tells me that they will do a callback to research the claim or situation further, when should I expect a call back?
A10. Per CMS regulations, Noridian does have up to 10 business days to call providers back with an update or an answer; however, we do our best to make the contact within 7 business days. It is required for the CSR to make three attempts to reach a provider and/or leave a message to request a return call. If the provider does not respond after three callbacks, the CSR will close the callback. In this case, providers may call in for the answer.
Q11. Where on the website can I get assistance with common claim submission errors?
A11. Noridian has created a Reason Code Guidance webpage containing a list of the most common Part A claim submission reason codes, descriptions of the issues and potential solutions.
Q12. What is an Accountable Care Organization (ACO)?
A12. An ACO is a group of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients. Participating in an ACO is purely voluntary for providers. If you have claims that are subject to the ACO and being reduced providers need to verify within their facility who authorized participation in the program.
Q13. Where can I find information about ACOs?
A13. Although there are other types of ACO models that can be found on the CMS website, the most recent is referred to as Next Generation ACO. Specific information such as those participating in the Next Generation ACO and how to apply can be found on the CMS website at: https://innovation.cms.gov/initiatives/Next-Generation-ACO-Model/
Q14. Who should I contact with my questions relating to the Next Generation ACO model?
A14. If you have specific questions relating to the Next Generation ACO model, please send them to NextGenerationACOModel@cms.hhs.gov.
Noridian will not be able to answer any questions you have relating to your enrollment in an ACO.
Q15. How does a provider identify ACO processed claims?
A15. In Direct Data Entry (DDE) on page 1, providers will see the following value codes that are populated on ACO claims:
- Q0 – Accountable Care Organization Reduction
- Q1 – ACO Payment Reduction
These value code amounts will appear as the amount in which the payment has been reduced based on agreements the provider has with their designated ACO.
Q16. How would a provider obtain pre-authorization for prescription drugs for a beneficiary?
A16. Prescription drugs are covered under Medicare Part D. A beneficiary has many Medicare Part D drug plans available to choose from. Please refer to the back of the Medicare Part D card for contact information to obtain a pre-authorization. This information is not available through the Provider Contact Center.
Q17.Where can a provider find out who the patient has elected for their Part D/drug coverage?
A17. The Provider Contact Center (PCC) customer service representatives (CSRs) do not have access to a beneficiary's Part D coverage information. Physician or suppliers must contact the beneficiary to confirm who they have elected for coverage. If they are unaware of who they have elected, the beneficiary must contact the Beneficiary Call Center.
Q18. Does Medicare preauthorize services?
A18. Under Medicare law, payment for services and supplies is based upon the reasonableness and necessity of the services performed and supplied, and is determined on a case-by-case basis. Medicare is unable to preauthorize coverage of an anticipated service or supply. If a provider is in doubt as to whether Medicare will cover a service or supply for a specific patient, he/she may safeguard themselves by having the beneficiary sign a waiver of liability ABN prior to having the service performed. A waiver holds the beneficiary liable for the service should it be denied for medical necessity reasons. If an ABN is obtained, the service must be appended with a GA modifier.
Q19. Why does the IVR now provide eligibility details while checking claim status?
A19. Noridian added a new feature to the IVR called "Jump Point." This new feature will now allow providers to obtain eligibility details while checking claim without having to go back to the main menu. Jump Point will not change how the IVR is currently used just automatically provides the details for claim denials related to the following topics:
- Managed Care
- Part A and B Effective Dates
- Inpatient Hospital Stay Overlaps
For any questions regarding the IVR Jump Point, please contact the PCC.
Q20. The Part A Call Center no longer transfers callers to the IVR. Why?
A20. For external tracking purposes, the PCC staff are no longer able to transfer calls to the toll-free numbers. Please follow the IVR call router if having difficulties reaching the correct department on the single toll free line.
Q21. Where can I find more information on the new Medicare Cards?
A21. See the CMS New Medicare Cards webpage.
Q22. What should I do if a claim is hitting for an overlapping reason code?
A22. Noridian has published an Overlapping Claim Resolution Tips assistance document to help providers. Overlapping facility NPIs can also be found in our Noridian Medicare Portal (NMP).
Last Updated Wed, 13 May 2020 18:48:46 +0000