NMP, IVR, and RA Claim Status Elements Comparison

Claim Status details are available within the Noridian Medicare Portal (NMP) and the Interactive Voice Response (IVR). To access such information, follow the below.

Self Service
Technology
Option/Functionality Authentication Requirements
NMP Claim Status Provider: Tax ID, NPI, PTAN, and Program
Beneficiary: Medicare number, first and last name, and DOB
IVR Option 2 - Claim Status Provider: NPI, PTAN, last five digits Tax ID
Beneficiary: Medicare number, first and last name, and DOS

 

Pick a self-service tool to see what it shares about a claim.

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IVR

"What is the X for this claim?"

The IVR starts by sharing the following information about a claim:

  • Number of claims on file for the DOS
  • Claim status (Processed, Pending or Denied etc.)
  • Receipt Date
  • Dates of service
  • Type of Bill
  • Total Charges
  • Claim Location

If the caller says "Claim Details", the following information is shared when available:

  • Finalized Dates
  • Processed Medicare Primary/Secondary
  • Reason Code Narrative
  • Provider Reimbursement
  • Deducible and Coinsurance Applied
  • Patient Responsibility
  • Total Non-Covered Charges
  • Check Number
  • Document Control Number (DCN)
  • Liability of denied claims
NMP

"What is the X for this claim?"

NMP starts by sharing the following information:

  • The Document Control Number (DCN)
  • Status
  • Billed Amount
  • Finalized Date
  • Provider Paid Amount
  • Bill Type
  • Receipt Date
  • MSP Indicator
    • Y - Medicare is secondary payer
    • N - Medicare is primary
  • Crossover Indictor
    • Y - Claim is a crossover claim
    • N - Claim is not a crossover claim
  • Last Worked Date
  • Check/EFT #
  • Noncovered Charges
  • Location
  • Line
  • From Date of Service
  • To Date of Service
  • Current Procedure Terminology Code (CPT)
  • Modifier
  • Diagnosis Code
  • Allowed Amount
  • Contractual Amount
  • Patient Responsibility
  • Billed Amount
  • Provider Paid
  • Reason Code

 

NMP is able to share details related to common beneficiary related denials, through Claim Status.

What information are you looking for?

Date of Death

Date of Death Denials will share the current DoD

It will also give the following general advice,

  • For the beneficiary or representatives to contact Social Security for updates with the phone number.
  • Instructions from CMS on how claims and the system will handle dates of death updates with a link.
Entitlement

Entitlement denials will share the following information

  • Any current and previous Part A entitlement dates
  • Any current and previous Part B entitlement dates.

It will also give the following general advice,

  • That beneficiaries contact the Social Security office for updates to their records with the phone number.
HMO - MA Plan Denials

HMO/MA Plan Denials will share the current plan on file for the beneficiary

  • Start and end date
  • The Plan ID
  • The plan's name and address

It will also give the following general advice to the user,

  • Advice for the bene to contact the plan for any updates.
Home Health

Home Health Denials will share the current plan on file for the beneneficiary

  • From Date
  • Thru Date
  • The HHA's NPI

It will also give the following general advice:

  • To get the facility details through the NPI registry with a link.
  • CMS website references for the basics of Home Health care coverage.
Hospice

Hospice denials will share the current hospice on file

  • From Date
  • Thru Date
  • Provider's NPI
  • If the hospice stay is not revoked, it will show the previous dates for the provider too.
  • If the hospice stay is revoked it will only show the related dates.

It will also give the following general advice:

  • To get the facility details through the NPI registry with a link.
  • IOM reference for the basics of Hospice coverage.
MSP Denials

MSP Denials will share each current valid and effective primary for the beneficiary

  • MSP type
  • Name of the insurer
  • Insurer address
  • Policy number
  • Effective and term dates

It will also give the following general advice to the user:

  • To contact the BCRC for updates (number included)
  • Reference to the IOM for MSP
  • Reference to the MSP topics page on noridianmedicare.com

 

Last Updated Mon, 31 Dec 2018 12:14:56 +0000