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End User Manual for the Noridian Medicare Portal

Eligibility

View a beneficiary's Medicare eligibility: Part A, Part B, Managed Care Organization (MCO) and Health Maintenance Organization (HMO), Medicare Secondary Payer (MSP), Home Health, Hospice, End Stage Renal Disease (ESRD), and Preventive Services.

When entering information into the inquiry screens in the portal, copy and paste functionality may cause extra spaces to be entered. In this case, the portal will state the beneficiary information is invalid. Ensure no extra spaces are entered.

Inquiry

  • Choose Tax Identification Number (TIN) or Social Security Number (SSN), National Provider Identifier (NPI) and Provider Transaction Access Number (PTAN) combination under Provider/Supplier Details
  • Complete mandatory fields (Health Insurance Claim Number (HICN) and Last Name) and enter beneficiary's first name and/or date of birth. The name must be entered as it states on beneficiary's Medicare card. Complete optional details to narrow search

If a specific date of service is in question, enter the date(s) in the From Date and To Date fields. Otherwise, the beneficiary's eligibility will display for the current date.

Eligibility Benefits Inquiry screen is displayed.

Response

The HIPAA Eligibility Transaction System (HETS) is considered the authoritative source for beneficiary Part A and B effective and termination, demographic, MCO and HMO, and ESRD data. For CMS purposes, authoritative source means the data originates here and is shared with other systems. View more information on HETS on the CMS website This link will take you to an external website. .

Eligibility Benefits Results are Displayed.

Each tab provides specific information.

Field Name

Description

Eligibility

  • Part A and B effective and termination dates
  • Deductible remaining
  • Ineligible Period (Due to classified as unlawfully present, deported or incarcerated)
  • Beneficiary address
  • Occupational, physical, and speech therapy
  • Blood deductible

Managed Care Organization (MCO) and Health Maintenance Organization (HMO)

  • Insurer name
  • Policy number
  • Effective and termination dates
  • MCO Plan Type
  • MCO Bill Option Code
  • Address

Medicare Secondary Payer (MSP)

  • Insurer name
  • Policy number
  • Effective and termination dates
  • Insurer type
  • Address

Home Health Episode History (HHEH)

  • Payer name and ID
  • Provider number
  • Episode start and end date
  • Earliest and latest billing dates

Hospice

  • Episode effective and termination dates
  • Provider number

Hospital

  • Earliest and latest billing dates
  • Deductible remaining
  • Full days remaining
  • Lifetime reserve days remaining
  • Lifetime Psychiatric remaining and base days
  • Copayment days remaining
  • Copayment amount remaining

Skilled Nursing Facility (SNF)

  • Earliest and latest billing dates
  • Days remaining
  • Copayment days remaining
  • Copayment amount remaining

End Stage Renal Disease (ESRD)

  • Effective date
  • Benefit type

Preventive

  • Smoking cessation benefit information
  • Preventive services benefit information
  • HCPCS code/Description/next eligibility date

 

Preventive Service CPT / HCPCS

  • 77057
  • 80061
  • 82270-26
  • 82270-TC
  • 82465
  • 82947
  • 82950
  • 82951
  • 83718
  • 84478
  • G0102
  • G0101-26
  • G0101-TC
  • G0103-26
  • G0103-TC
  • G0104
  • G0105
  • G0106
  • G0117
  • G0118
  • G0120
  • G0121
  • G0123
  • G0143
  • G0144
  • G0145
  • G0147
  • G0148
  • G0202
  • G0328-26
  • G0328-TC
  • G0389
  • G0402
  • G0403
  • G0404-TC
  • G0405-26
  • G0438-26
  • G0439-26
  • G0444
  • G0445
  • G0446
  • G0447
  • P3000
  • Q0091-26
  • Q0091-TC 

Claim Status

View the status of claims, view Medical Review comments and initiate a reopening or redetermination on finalized claims.

When entering information into the inquiry screens, copy and paste functionality may cause extra spaces to be entered. In this case, the portal will state the beneficiary information is invalid. Ensure no extra spaces are entered.

Inquiry

  • Choose the TIN or SSN, NPI and PTAN combination under Provider/Supplier Details.
  • Complete the mandatory fields in the Beneficiary Details section. Complete optional fields to narrow the search.

Entering a date of service is suggested to narrow the number of results.

Claim Status Inquiry screen is displayed.

Response

Select the "View Claim" link to receive additional claim information.

Information received should match the Interactive Voice Response (IVR) system. Consult the Provider Contact Center if information returned is not as expected.

Effective March 24, 2016, the Noridian Medicare Portal will display all diagnoses submitted on a claim and identify which diagnosis is indicated as the primary diagnosis per line item on a claim. 

Claim Status Response with Claim Diagnosis Code and Pointer Details

The following table provides the field name and the description of the field.

Field Name

Description

Internal Control Number (ICN)

  • Unique number assigned to claim at the time received by contractor
  • Used to track and monitor claim

Status

Status of claim, e.g. finalized or pending

Billed Amount

Total charges submitted

Finalized Date

Date when claim completed the adjudication process

Provider Paid Amount

Total amount paid to provider

Specialty

Physician Specialty Code

Total Deductible

Dollar amount applied to beneficiary's deductible

Receipt Date

Date claim was received

MSP Indicator

  • "Y" indicates Medicare is secondary payer
  • "N" indicates Medicare is primary payer

Crossover Indicator

  • "Y" indicates claim is a crossover claim
  • "N" indicates claim is not a crossover claim

Crossover claims are automatic electronic transfer of payment information on finalized claims to supplemental insurance companies and Medicaid that have signed agreements

Last Worked Date

Date the last time claim was examined

Check/EFT#

  • Number on check issued for payment
  • If Electronic Funds Transfer (EFT) was used for payment, this field displays trace number

Line

Service line number of the claim

From DOS

Beginning date of service (DOS) for the claim billing period

To DOS

End date of service for the claim billing period

HCPCS

Healthcare Common Procedure Coding System (HCPCS) codes

Modifier

Code that adds specification to HCPCS categorization

Units

Number of units billed on the claim

POS

Place of Service (POS) code

Diagnosis Code

  • First code displayed is ICD-9-CM code describing principal diagnosis
  • Remaining codes correspond to additional conditions that coexisted

Billed Amount

Dollar amount billed for this line item

Allowed Amount

Total amount allowed for the service line

Provider Paid

Amount provider was paid

Reason Code

National administrative code set that identifies reasons for any differences or adjustments between original provider charge and payer's payment

 

Claim Processing Comments

The portal offers access to view claim processing comments if a claim had been selected for prepayment review in which Noridian requested documentation prior to making a claim decision. In the event a claim was not suspended during processing, this option will not be presented.

First, perform a Claim Status Inquiry as described above.

If the claim had a history of being reviewed for additional documentation, the portal will offer a "Noridian Comments" link in the claim header.

Part B Claim Status Results with Noridian Comments button is displayed.

After selecting this link, the claim processing comments will be retrieved and presented.

Claim Processing Comments are displayed.

Note: Protected Health Information (PHI) is not included within the Noridian examiner's comments.

There may be a rare occasion where a claim's history does not have comments associated with it; however, the portal might offer the "Noridian Comments" feature. In this situation, a message will be displayed indicating comments are not available.

Related Claim Details

The portal offers Part B providers access to gain more information about a finalized claim that was denied or received a reduced payment due to related services. Types of claim situations providers can research include National Correct Coding Initiative edits, pre- or post-operative care following a service that had a global period, and/or duplicate claims. 

First, perform a Claim Status Inquiry as described above. Select the desired claim.

If the finalized claim processing history reflected the claim was denied or partially reduced due to a previously processed claim, a Related Claim Details link is offered in the claim header.

Claim Status Details with the Related Claim Details button is displayed.

After selecting this option, the details of the related claim are presented. If the claim was billed by a different group PTAN, the date or service, rendering provider name and the billing provider's phone number will display. If the claim was billed by the same group PTAN, the ICN and remittance advice date will also be displayed.

Related Claim Details response is displayed.

Self Service Reopenings

Providers may create a self-service reopening for the following:

  • Add, replace or remove diagnosis codes
  • Add, replace or replace modifiers
  • Billed in error
  • Reprocess a claim

A self-service reopening is submitted by performing a claim status inquiry first. The Self-Service Reopening link is located under Related Inquiries.

This image shows the location of the Self-Service Reopening link on the Claim Status Details page.

Step 1: Selection

After selecting the link, if the message "Selected claim is not eligible for Self-Service Reopening. Please select another claim or submit a written reopening or redetermination" displays, this indicates one or more of the following requirements were not met. The claim:

  • Remittance date is within one year of current date
  • Must be finalized
  • No Additional Documentation Request (ADR) sent
  • Not previously reviewed by any entity
  • Cannot be previously appealed
  • Procedure code and modifier not too complex

Items Too Complex for Self-Service Reopenings

  • Claims with initial determination dates over one year old
  • Claims reviewed by CERT, Medical Review, Redeterminations, Recovery Auditor, Recoupment, ZPIC or paid by another contractor
  • Modifiers: AQ, GA, GY, GX, GZ, PA, PB, PC, QA, QJ, QU, QV, Q1, 21, 22, 23, 66, and 74
  • Procedure codes: A0021-A0999, G0452, J0881-J0886, J7183, J7185-J7195, J7197-J7199, Q4081, 22520-22525, 64493-64495, 64635-64636, 76942, 77261-77799, 81200-81383, 81400-81479, 83890-83914, 84999, 85999, 86849, 87999, 88199, 88299, 88367-88368, 88380-88381, 88384-88386, 88399, 89398, 99285, 99291-99292, 99495-99496

If all of these requirements are met, the reopening begins. First, select the Adjustment Type:

  • Modifier
  • Diagnosis
  • Reoprocessing
  • Billed in Error

Next, check the box next to the claim lines the reopening pertains to.

Note: If the boxes cannot be checked, this indicates the line item is too complex and the reopening cannot be done through the portal for that item.

This image shows Step 1 of the Reopening process.

Step 2: Corrections

Modifiers
If Modifier was selected, providers may add, replace or remove modifiers.

This image shows Step 2 if Modifier is the selected Adjustment Type.

Diagnosis
Providers may change any of the diagnosis codes or pointers listed on the claim.

Adding diagnosis

  • Locate an available pointer in the diagnosis table
  • Input the new diagnosis
  • If applicable, update the detail line with the appropriate diagnosis pointer

Removing diagnosis

  • Locate the diagnosis in the diagnosis table
  • Delete the diagnosis
  • If applicable, update any detail lines, that contain that diagnosis pointer, with a valid pointer

Changing diagnosis

  • Locate the diagnosis being replaced
  • Input the new diagnosis over the replaced diagnosis
  • If applicable, update any details lines with the appropriate diagnosis pointer

Note:

  • Primary Diagnosis cannot be left blank
  • All lines must contain a diagnosis pointer

This image shows Step 2 if Diagnosis is the selected Adjustment Type.

Reprocess
Providers may choose to reopen the claim as it was originally billed. An example of this is when the beneficiary's eligibility has changed for the date of service on the claim; no changes are needed but the claim does need to reprocess.

Billed in Error
A provider may indicate the claim line(s) should not have been billed. No changes are needed to the claim; however, an overpayment will be created.

This image shows when Reprocess is selected as the Adjustment Type on Step 1.

Step 3: Submission

Step 3 provides the user with updated claim lines. Verify the changes and submit the request using the Confirm Changes button.

This image shows Step 3 of the Reopenings process, where providers confirm the changes made to the claim.

Step 4: Confirmation

Step 4 provides the Confirmation ID number of the reopening. This indicates the reopening was submitted and will be processed.

This image shows Step 4, Confirmation, of the reopening.

Follow-up

To follow-up on the processing of the reopening, view the adjusted claim under Claim Status. The adjusted claim will be viewable one business day after the reopening is submitted.. These adjustments display with the claim number ending in the number ‘1'.

This image shows the adjusted claim under the Claim Status option.

Providers may call Customer Service with questions or for assistance. Do not call Telephone Reopenings; this line is for reopening claims only.

Financial Information

View pending and finalized check information issued to an NPI/PTAN combination.

Inquiry

  • Select Financial from top navigation or home page and then Payment Results tab
  • Choose TIN or SSN, NPI and PTAN combination under Provider/Supplier Details

Financial Payment Results inquiry

Response

The portal provides the most recent 50 checks and the following:

  • Number of pending claims and dollar amount
  • Number of claims approved-to-pay and dollar amount
  • Number of claims paid month-to-date and dollar amount
  • Number of claims paid year-to-date and dollar amount

Appeals Status Inquiry

Noridian processes reopening and redetermination requests within 60 days of receipt.

Inquiry

To check the status of a reopening or redetermination, select the TIN or SSN, NPI and PTAN it was submitted under and select one of the following options:

  • Option 1 – View Last 100 Appeals
  • Option 2 –  Search Existing Appeals
    • HICN
    • Appeal Status (Pending, Finalized, Additional Documentation Needed)
    • Confirmation Number

Appeals Status Inquiry is displayed.

Response

The results will display the confirmation number, claim number, HICN, status and date submitted. To view more information on the request select View Appeal. A list of the submitted documentation displays. To view the document, select View Document. If additional documentation is needed, select "Add a Document".

The decision letter from Appeals is available to view when the request is finalized. Letters are only available for partially favorable and denied appeals. Providers are notified of favorable decisions through the remittance advice.

Appeals Status Results are displayed.

Begin New Appeal

A new appeal can also be submitted by performing a claim status inquiry and following the same steps.

Inquiry

  • Choose TIN or SSN, NPI and PTAN combination under Provider/Supplier Details
  • Complete mandatory fields in Beneficiary Details section. Complete optional fields to narrow search.

Response

The results will display based on the criteria entered. To begin the appeal choose View Claim.

Additional claim details are provided. To begin the appeal choose the Redetermination/Reopening Submission button.

Begin New Appeal Claim Status Results are displayed.

Reopening or Redetermination Request Form

The Reopening or Redetermination Request form displays. User sessions time out after 30 minutes of inactivity. Ensure all information is gathered prior to beginning the request. There are four steps to complete an appeal.

Redetermination/Reopening Details

The claim details are provided and the following questions are asked:

  • Type of Request – Redetermination or Reopening
  • Will a review of this claim cause an overpayment?
    • If answered yes, users are prompted to request a recoupment. The appeal process will not continue.

Reopening and Redetermination form is displayed.

  • Is this request the result of an overpayment?
    • If answered yes, users are asked who initiated the overpayment (Benefit Integrity, Comprehensive Error Rate Testing (CERT), Medical Review, Office of Inspector General (OIG), Recovery Auditor, Supplemental Medical Review Contractor (SMRC) or Zone Program Integrity Contractor (ZPIC)/Program Safeguard Contractor (PSC)). The Accounts Receivable (AR) Number is then required. The AR number is found on the overpayment letter from Noridian.

Appeals form Submission Details are displayed.

  • The contact person (portal user submitting the request) information is also displayed. Address information is requested on an appeal, however, this information is not required.

Appeals form Contact information is displayed.

  • Next, providers will enter the claim details and an explanation as to why the appeal is being submitted and any other information is needed for the Noridian examiner.

Appeals form details and explanation are displayed.

  • In the Claim Status Line Details section, users must check the box next to the line item the reopening or redetermination is being requested on. Note: Checking all will initiate an appeal on all lines regardless of whether they are paid or denied. This may result in a loss of further appeal rights.

Appeals form claim status line details are displayed.

  • Select Next.

Electronic Signature

Users must read the attestation. If agreed, the user must type their name under "Signatory Name" and check the box next to "I have read the attestation and agree." Select the Submit button.

Reopening and Redetermination Electronic Signature screen is displayed.

Add Documents

To attach documentation, select the "Add Document" button. Title the document so it is recognizable when reviewing the submission and browse to locate it. Numerous documents may be added during this step. If more than one file is needed to be uploaded, select the "Add Document" button again to add another file. Once this is completed, select the Next button. If a document needs to be removed, select the Delete link in the last column.

Reopening and Redetermination form add documents screen is displayed.

Confirmation

Step 4 displays a successful upload message and show the appeal information below. To add additional documents, choose the "Add Document" button on the bottom of the screen.  

In the event a provider has submitted a reopening/redetermination and he/she wants to delete/dismiss, a document explaining the dismissal/deletion needs to be created on the company letterhead and must contain an original, "pen and ink" true signature. This dismissal request needs to be uploaded as an attachment to the existing appeal.

Appeals inquiry confirmation is displayed.

Claim-Specific Remittance Advices

View and/or print a remittance advice information for a single claim.

Inquiry

  • Select Remittance Advices from home page
  • Choose TIN or SSN, NPI and PTAN combination under Provider/Supplier Details
  • Enter number of claim

Claim Specific Remittance Advice inquiry is displayed.

Response

A copy of the claim-specific remittance advice displays. To print the claim-specific remittance advice, select "Printable Version" in the upper left corner. (The information that appears on this screen will vary depending on the claim). Definitions of remark and reason codes are provided at the bottom of the screen.

Claim Specific Remittance advice response is displayed.

Full Remittance Advices

Part B providers may view, save and print full remittance advices.

Inquiry

  • Select Full Remittance Advices from the main menu.
  • Choose the TIN or SSN, NPI and PTAN combination under Provider/Supplier Details.
  • Select one of the following options:
    • Option 1 – View remittances issued within the last 30 days
    • Option 2 – Narrow the search results down by a specific date range, check amount or check number

Full Remittance Advice Inquiry is displayed.

  • When entering the check amount, do not use the dollar sign or comma. The only symbol allowed in this field is the decimal point after the dollar amount.
  • No-pay remittance advices can be viewed by entering 0.0 in the Check Amount field.
  • The portal limits the number of remittance advices displayed on the results page to 100.

Response

Results are provided in a list which includes the date issued, the check number, check amount and the number of pages included in the document.

To view the remittance advice in PDF format, select View PDF. The remittance advice is savable and printable once opened.

Remittance advices too large for the portal to display will be indicated with an asterisk. Providers may call Customer Service for assistance in ordering these items.

Full Remittance Advice results are displayed.

NMP Browser Compatibility

The Noridian Medicare Portal is accessible from several different web browsers; however, only certain browsers are supported. View the chart below to determine the browser requirements for using the portal. Using older browsers, non-compatible browsers, or disabling browser features such as JavaScript, may reduce functionality in website.

Supported Browsers

Providers can check their browser version by going to the Help menu and selecting "About...." A screen will appear showing which browser and version is being used.

The Noridian Medicare Portal is best viewed when the display resolution is set to 1024 x 768 or above. If the settings are below 1024 x 768, additional scroll bars will be encountered.

Support Contact Information

Have the following information available: User name and/or email address, NPI/TIN/PTAN

  • User Security is available to assist providers with questions regarding registration, logging in to the portal, technical difficulties with availability or functionality, and password reset requests.
  • Customer Service is available to assist with any questions you may have regarding the results of the inquiry response.

Other Contacts

Providers and beneficiaries may need to call other contractors in order to update or inquire on the information provided in the eligibility function of the portal.

  • Beneficiary Call Center - 1-800-MEDICARE (1-800-633-4227)
  • Coordination of Benefits - 1-855-798-2627
  • Home Health - To update information, beneficiary must contact Home Health Agency
  • Social Security Administration (SSA) - To update information, beneficiary must contact SSA at 1-800-772-1213

Security Awareness Training and Recertification

  • Security Awareness Training - Security Awareness Training occurs upon the first login and will occur on a yearly basis in conjunction with the recertification. The process will initiate 45 days prior to the last day of the month in which the users account was initially setup. This training must be completed within the 45 day period in order to continue using the portal. If this training is not completed within the timeframe, the user's account will be disabled and the user must contact Noridian Medicare Portal Support in order to unlock it. Upon logging in again, the user will be prompted to complete the training. If the training is not completed within 90 days, the user's account will be deleted and the user must re-register.
  • Recertification - Portal users will be prompted to recertify accounts on a yearly basis. This recertification demonstrates the Noridian Medicare Portal account is being used by the appropriate person. The process will initiate 45 days prior to the last day of the month in which the users account was initially setup. The recertification must be completed within the 45 day period in order to continue using the portal. If the account is not recertified within the timeframe, the user's account will be disabled and the user must contact Noridian Medicare Portal Support in order to unlock it. Upon logging in again, the user will be prompted to recertify the account. If it is not recertified within 90 days, the user's account will be deleted and the user must re-register.

Last Updated Oct 20, 2016