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Interactive Voice Response (IVR) - JE Part B

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IVR Conversion Tool

PTAN and Medicare Number Conversion

Name Conversion

 
 

IVR Conversion Tool IVR Guide NMP vs IVR Comparision

Interactive Voice Response (IVR)

Access the below IVR related information from this page.

Availability

  • General IVR inquiries available 24/7
  • Claim-specific inquiries available: Monday-Saturday 4 a.m. - 7 p.m. PT for CA, Monday-Friday 4 a.m. - 9 p.m. PT for HI, NV, AS, GU and MP, Saturday - 4 a.m. - 7 p.m. PT for HI, NV, AS, GU and MP
  • 855-609-9960

Call-in Tips

  • It is important that callers listen to the IVR prompts as they will provide navigational instructions
  • Call from a quiet environment using a telephone with a handset or headset
  • Use of speaker phones and cell phones is not recommended
  • Speak clearly and naturally into telephone
  • Bypass upfront messaging by saying "Main Menu" or pressing # key on telephone keypad
  • Selections may be keyed or spoken without waiting for entire prompt to play
  • Say "Main Menu" at any time to go back to beginning of call flow
  • If IVR is having difficulty with information as spoken, try keying information with telephone keypad
  • Enter full Medicare number

If callers prefer to avoid the voice-recognition option offered from the IVR, use the IVR Conversion Tool to assist in determining the touch-tone data-entry.

Authentication Elements

To ensure that calls flow as quick and as productive as possible, be prepared with the below information. Depending on the inquiry and department, additional authentication details will be necessary. Failure to provide the IVR with all necessary information may result in inaccurate or incomplete returned results.

Provider Details Beneficiary Details
  • NPI - National Provider Identifier
  • PTAN - Provider Transaction Access Number
  • TIN - Tax Identification Number (Last five digits)
  • Beneficiary Name
  • Beneficiary Medicare Number
  • Beneficiary Date of Birth
  • Date of Service

 

Touch Tone Feature for Entering Letters

To enter a numeric value, use the corresponding number on telephone keypad. The three-key combination works as follows.

  • Select *(star) key
  • Select key on telephone keypad which contains letter
  • Select key which represents position of letter on keypad
  • Example: PTAN 55t551     Key Entry: 55*81551
View the complete listing of letters and their corresponding three-key combinations
  • A *21
  • B *22
  • C *23
  • D *31
  • E *32
  • F *33
  • G *41
  • H *42
  • I *43
  • J *51
  • K *52
  • L *53
  • M *61
  • N *62
  • O *63
  • P *71
  • Q *72
  • R *73
  • S *74
  • T *81
  • U *82
  • V *83
  • W *91
  • X *92
  • Y *93
  • Z *94

 

Route Call in the Right Direction

Main Menu

All calls begin at the Main Menu where a caller is immediately able to choose the desired customer service area, from below table, in which to direct his/her inquiry to. NOTE: The touch tone options are not provided during this initial prompt, so it is best to have this information ready when calling.

During Noridian business hours, callers may say "operator," “agent", or press "0" (zero) to be transferred to a Customer Service Representative when the IVR is unable to complete the desired inquiry and/or there are still questions about the information it did provide.

When navigating within the IVR, callers may speak "Main Menu" to return to this high-level menu option.

IVR Guide

Open All Listings   |   Close All Listings

Part A or Part B General Inquiries

Verbal Response: General | Touch Tone Response: 1

Future eligibility dates are not accepted.

Eligibility

Verbal Response: Eligibility| Touch Tone Response: 1

Submenu Item Verbal Option Touch Tone Option
General
  • Part A and B effective/termination dates
  • Deductible Information for year of date of service
  • If patient is enrolled in an Health Maintanence Organization (HMO)
  • If patient has Medicare Secondary Payer (MSP)
 General Eligibility 1
MSP
  • MSP name, type, address (if available), policy number
  • Effective/termination date
  • Diagnosis codes
 MSP 2
HMO
  • HMO name, address (if available), phone number, type, plan code number
  • Effective/termination date
 HMO 3
Home Health
  • Effective/termination date
  • HH NPI
 Home Health 4
Hospice
  • Effective/termination date
  • Hospice NPI
 Hospice 5

Preventive

  • Next elgible date
 Preventive 6
Details
  • Physical and Occupational Therapy limits
  • Skilled Nursing Facility (SNF)
  • Is there a Part A stay which may include SNF
  • Earliest/latest date of Part A stay
 Eligibility Details 7

 

Claim Status

Verbal Response: Claim Status | Touch Tone Response: 2

Additional Provider Authentication Elements

  • Patient Medicare number
  • Start and end date of service
  • Patient name as it appears on Medicare card

At any time, caller may:

  • Change Medicare number, NPI, or PTAN number
Claim Status Provides Caller Must Say "Details" to Hear
  • Number of claims (in given date range)
  • Internal Control Number (ICN)
  • Claim Status (unprocessable, processed, denied, pending)
  • Whether it is a primary or secondary claim
  • Receipt date
  • Amount submitted, allowed, applied to deductible
  • Claim location
  • ADS date
  • Provider paid amount
  • Check number and date
  • Date of service
  • Place of service
  • Procedure code
  • Modifier
  • ICD-10 code
  • Amount submitted
  • Paid claim - allowed/paid amount
  • Denied claim - Denial message. Duplicate ICN, if applicable
Financials

Verbal Response: Financials | Touch Tone Response: 3

Submenu Item Verbal Response Touch Tone Response
Check Information
  • Check date, number, amount, status, status date
  • Number of claims
 Checks 1
Offset Information
  • Beneficiary name
  • Date of service
 Offsets 2

Payment Summary

  • Number/dollar amount of pending claims
  • Number/dollar amount of approved to pay claims
  • Number of finalized claims month-to-date and year-to-date
  • Dollar amount of MTD and YTD
 Summary 3

 

Procedure Code Pricing

Verbal Response: Patient Code Pricing | Touch Tone Response: 4

EDI

Verbal Response: EDI | Touch Tone Response: 2

Is the call related to the Noridian Medicare Portal registration or password assistance?

Verbal Response

  • Say Yes - Caller will be transfered to User Security department
  • Say No - Caller will be asked if his/her inquiry is general or password related
    • Say General for general EDI questions
    • Say Passwords for EDI passwords

NOTE: Vendors who do not have a specific NPI or PTAN available, say Agent to speak with a representative.

Enrollment

Verbal Response: Enrollment | Touch Tone Response: 3

Is caller calling to obtain EDI Trading Partner or Submitter ID?

Verbal Response

  • Say Yes - Caller will be transfered to EDI department
  • Say No - Caller will be asked if his/her inquiry is regarding mailing addresses, application fees, or application status information
    • Say Yes - Caller will be directed to website for additional information based on his/her selection
    • Say No - Caller must provide the Provider Authentication Elements

NOTE: If caller does not have a specific PTAN assigned, he/she must state whether call is related to Part A or Part B.

Reopenings

Verbal Response: Reopenings | Touch Tone Response: 4

This is for Medicare Part B claims only.

Caller must provide Provider Authentication Elements and Internal Control Number (ICN) of claim he/she wishes to reopen.

User Security

Verbal Response: User Security | Touch Tone Response: 5

This selection is for calls related to Direct Data Entry (DDE), Noridian Medicare Portal (NMP) registration, or password assistance.

 

Resource

 

Last Updated Thu, 13 Oct 2022 16:52:09 +0000