NMP and/or IVR Use Required for Eligibility Inquiries - Effective February 5, 2018
Effective February 5, 2018, Noridian will require providers to use the Noridian Medicare Portal (NMP) and/or the Interactive Voice Response (IVR) for all eligibility inquiries. Until then, Customer Service Representatives (CSRs) will educate callers on these tools.
To access specifics about each, select the webpage links below.
- NMP: Provides 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), Medicare Secondary Payer (MSP), Home Health Episode History (HHEH), hospice, hospital periods, Skilled Nursing Facility (SNF) periods, End Stage Renal Disease (ESRD) effective dates and benefit type, and preventive information
- View the Eligibility Education-on-Demand Tutorial to describe eligibility inquiries and response features
- IVR: Provides effective and termination dates, deductible information, latest billing dates, lifetime reserve days, Managed Care (HMO), MSP, home health, hospice, SNF periods, pneumococcal vaccines, physical and occupational therapy limits, and date of death
- Direct Data Entry (DDE): Eligibility for providers who use DDE are not impacted by this change
The CMS Internet Only Manual (IOM), Publication 100-09, Chapter 6, Section 50.1 mandates that all providers first access inquiries through self-service technology, "…Providers shall be required to use the IVR system to access claim status and beneficiary eligibility information. CSRs shall refer providers back to the IVR system if they have questions about claims status or eligibility that can be handled by the IVR system…. Each MAC has the discretion to also require that providers use the Internet-based provider portal for claim status and eligibility inquiries if the portal has these functionalities."
This process change will allow Noridian to meet CMS requirements and our CSRs to assist callers with more complex inquiries which cannot be answered through these self-service tools.
Last Updated Feb 13, 2018