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Advance Beneficiary Notice of Noncoverage (ABN) - View an ABN overview, medical necessity, triggering events, tips, key points and resources.

Appeals - If dissatisfied with an initial claim determination, you have the right to request an appeal. There are many appeal levels and each level must be processed before proceeding to the next.

Claims - Access the CMS-1500 instructions and tutorial and view other claim submission related information.

Clinical Trials - View information on the different clinical research studies, Medicare coverage for those types, as well as billing guidance and scenarios and solutions.

Compliance Program - View overview of Medicare compliance program requirements.

Documentation Requirements - View checklists to help providers submit appropriate documentation to Medicare.

Drugs, Biologicals and Injections - View guidance on drugs, biologicals and injections.

Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) - Access the Noridian DME Homepages, Latest Updates, contact information, Local Coverage Determinations (LCDs) and articles and Jurisdiction Lists.

Electronic Data Interchange (EDI) - Connect with EDI regarding electronic claim submissions.

Emergencies and Disasters - In the event of a national or regional catastrophe or disaster, view resources.

Fraud & Abuse - View information regarding fraud, abuse, and the related process to report potential concerns.

Home Health - View certification, recertification, and Care Plan Oversight (CPO) coverage for home health and hospice services.

Hospice - Hospice care is a benefit under the hospital insurance program.

Incentive Programs - View variety of CMS programs with financial incentives for providers.

Incident To - View criteria, terminology, direct supervision, direct personal supervision, employment and billing information.

Medicare Secondary Payer (MSP) - View general MSP related information, information on Benefits Coordination & Recovery Center (BCRC), billing electronically, payment examples and access the payment calculator.

Modifiers - Modifiers can be two digit numbers, two character modifiers, or alpha-numeric indicators.

Non-Covered Services - View the differences between not medically necessary services/items and those statutorily excluded.

Noridian Medicare Portal (NMP) - Access General, Registration, End User, and Administrator function related guides and details.

Overpayment and Recoupment - Overpayment: Repayment, interest rates, and types. Recoupment: Request an immediate recoupment, respond to demand letter and submit a voluntary refund.

Preventive Services - Medicare pays for many preventive services to keep beneficiaries healthy.

Promoting Equity - CMS Framework for Health Equity develops policies and programs to eliminate avoidable differences in health outcomes by providing the care and support Medicare beneficiaries need to thrive.

Remittance Advice (RA) - View/access RA related information. Qualified Medicare Beneficiary (QMB) Program, Reason Code guidance, WPC reason and remark codes.

Telehealth - Beneficiaries are eligible for telehealth services only if they are treated at an originating site located either in a rural health professional shortage areas (HPSA) or in a county outside of a Metropolitan Statistical Area (MSA).

Wound Care - View information regarding wound care related services.

Last Updated Apr 23 , 2024

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