Provider Customer Service Frequently Asked Questions (FAQs)
Q1. Where can a provider find who the patient has elected for his/her Part D/drug coverage?
A1. The PCC CSRs do not have access to a beneficiary's Part D coverage information. Physician or suppliers must contact the beneficiary to confirm who he/she has elected for coverage. If they are unaware of who they have elected, he/she must contact the Beneficiary Call Center (1-800- MEDICARE).
Q2. How does a provider use the IVR if it doesn't understand his/her accent?
A2. The IVR not only allows a provider to speak the information but he/she can also use their telephone key pad. Access the IVR Conversion Tool on the IVR webpage. This tool provides the keys that will be required when using the key pad.
Q3. What functions are available on the Noridian Medicare Portal (NMP)?
A3. Visit the Noridian Medicare Portal webpage to view general info, registration details, End User and Administrator functions.
Q4. Is there a way to obtain the new Medicare Beneficiary Identifier (MBI) number without the patients new Medicare card?
A4. The Medicare Beneficiary Identifier (MBI) Look-Up Tool is now available in NMP. This tool is an option for providers/suppliers to use if they are not able to obtain the MBI number from the patient.
Q5. Why does the IVR now provide eligibility details while I am checking claim status?
A5. Jump Points allows providers to obtain eligibility details while checking claim without having to go back to the main menu.
- Managed Care
- Part A and B Effective Dates
- Inpatient Hospital Stay Overlaps
Q6. When the IVR states it has limited information, what information can I still receive from the IVR?
A6. The information that will be released from the IVR will be basic eligibility, this includes Part A and Part B effective dates, deductible, HMO, Medicare primary/secondary, and therapy caps. All this information is in the new format; however, you will need to choose the appropriate option to get the information. Additional information regarding the information available from the IVR is available on the Noridian IVR webpage within the Contact section of this website.
Q7. How long will it take for a claim to process?
A7. Per CMS regulations, all "clean" claims, or claims that do not require additional research or investigation, must be paid or denied within 30 days of receipt. If a paid claim does not pay in that time, interest is paid. The standard processing time for claims before payment is made is at least 14 days of processing for electronic claims, and at least 29 days for paper claims.
Q8. Can we charge the patient up front for the deductible?
A8. There is not a regulation stating that the patient can be charged up front. It may be difficult to bill the patient for their deductible since it is applied to the first claims processed, which could lead to the patient being overcharged, a risk to the provider. See the CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 1, Section 30.1.1 – Provider Charges to Beneficiaries.
Q9. If I do not know my Provider Transaction Number (PTAN), how can I request it?
A9. PTANs can be requested through Provider Enrollment, Chain, and Ownership System (PECOS). View the PTAN webpage for details.
Q10. What amount does Medicare use when calculating a beneficiary's therapy cap?
A10. The Medicare allowed amount is applied towards the therapy cap limit. This is true even if Medicare is secondary.
Q11. May I charge Medicare patients for missed appointments/no-shows?
A11. Yes. View "Missed Appointments" on Miscellaneous Services and Charges webpage.
Q12. When there is an offset on a Remittance Advice (RA), can a provider can find out which patient it is for without speaking to customer service?
A12. NMP can provide all claim details by using the Financial Control Number (FCN) when the FCN is based on a withholding of a claim.
- Select "Claim Specific Remittance Advice" option
- Remove first two digits of FCN (which identifies state region). Enter next 13 numbers as Internal Control Number (ICN)
- When search is completed, claim information for which offset occurred will be provided
Q13. A claim is denied for timely filing. Can anything be charged to the beneficiary?
A13. View details on Timely Filing webpage.
Q14. How does a provider request a Denial Only letter?
A14. View details on the Mandatory Claim Submission webpage.
Q15. When Medicare is secondary, will Medicare pick-up the primary deductible/coinsurance?
A15. Medicare is not a supplemental insurance. Medicare will take into consideration what the primary insurer pays and allows; however, will not pay above the allowed amount had we been the primary payer. See the MSP Payment Calculation Examples webpage to see how Medicare makes their payment.
Q16. Can we contact the Recoupment department without going through the Provider Contact Center first?
A16. No. The Provider Contact Center must first authenticate the provider information and confirm if the inquiry is appropriate for them.
Q17. Why will a provider receive a mandatory claim submission letter?
A17. View the Mandatory Claim Submission webpage for details.
Q18. Why weren't my ASC claims reduced for both the bilateral and multiple procedure guidelines?
A18. Bilateral pricing rules do not apply to ASC claims. When a claim is subject to multiple procedure discounting and is billed bilaterally, a 50 percent reduction is applied to one of the lines along with any other procedure subject to multiple procedure discounting. View pricing guidelines in CMS IOM, Publication 100-04, Chapter 14.
Q19. Does a patient's Medicare plan cover out of network benefits?
A19. Out of network benefits do not apply to Medicare. If a provider is enrolled in Medicare and a patient is present in the US, at the time of service, the provider may see the patient.
Q20. A provider submitted a Redetermination request on a claim that denied for timely filing but got a letter indicating that a claim denied for timely file cannot be appealed. Are there exceptions to this?
A20. View the Timely Filing webpage for details.
Q21. Does Medicare Preauthorize services? If so, how should a provider obtain pre-authorization for prescription drugs for a beneficiary?
A21. Under Medicare law, payment for services and supplies is based upon the reasonableness and necessity of the services performed and supplied 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 Advance Beneficiary Notice of Noncoverage (ABN) prior to having the service performed. A waiver holds the beneficiary liable
Q22. When providers ask CSRs which procedure code or diagnosis code they should bill with, why are they told to contact a coder or the American Medical Association (AMA)?
A22. It is the provider's responsibility to determine the correct procedure and diagnosis code for a patient based on what is furnished to the Medicare beneficiary. CSRs are not professional coders and do not have the experience to determine the proper use of codes. Address questions regarding Current Procedural Terminology (CPT) codes to the AMA. Questions regarding ICD-9-CM or ICD-10-CM diagnosis codes, contact the American Hospital Association's Coding Clinic. See more information in the CMS IOM, Publication 100-09, Chapter 6, Section 30.1.1.
Q23. Why can't a provider see all his/her appeals within NMP?
A23. There are times that a submitted appeal must be forwarded to a different department such as Medicare Secondary Payer. In these situations, the appeal cannot be viewed within NMP. To check the appeal status, contact the PCC.
Q24. Is a provider able to request crossover information from a CSR?
A24. A provider's primary source of crossover information is the Remittance Remark Code (RARC) on the RA. This notifies the provider if Medicare made its payment determination and crossed the claim over to the supplemental insurance. Even when the beneficiary has multiple supplemental insurers, an RA only shows one crossover. CSRs may provide crossover information when assisting callers with claim status inquiries that cannot be completed via the IVR or NMP.
Last Updated Mar 25, 2019