NMP and/or IVR Required Use for HMO or Managed Care Plan Inquiries - Effective March 8, 2019

Effective March 8, 2019, providers will be required to use the Noridian Medicare Portal (NMP) and/or the Interactive Voice Response (IVR) self-service tools to access the below Health Maintenance Organization (HMO) or Managed Care Plan related information.

NMP

  • Insurer Name
  • Policy Number
  • Managed Care Organization (MCO) Plan Benefit Package (PBP) Plan Number
  • MCO PBP Plan Name
  • Effective and Termination Date
  • MCO Plan Type
  • MCO Bill Option Code
  • Address and Phone Number

IVR

  • Whether or not there is an HMO
  • HMO Name
  • HMO Type
  • Plan Code Number
  • HMO Address, if available
  • Phone Number
  • Effective and Termination Date

Note: Referring providers to the self-service options is a CMS requirement. Per the CMS Internet Only Manual (IOM), Publication 100-09, Medicare Administrative Contractor (MAC) Beneficiary and Provider Communications Manual, Chapter 6, Section 50.1 "Providers shall be required to use IVRs to access claim status and beneficiary eligibility information. CSRs shall refer providers back to the IVR if they have questions about claims status or eligibility that can be handled by the IVR ... 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. See our Provider Contact Center webpage for further information.

 

Last Updated Mar 07, 2019