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 (Pending, or Processed)
  • Total billed amount
  • Total allowed amount
  • Total amount applied to deductible
  • Total paid amount
  • Finalized date
  • Check number

The caller then has the option to order a single claim remit.

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

  • ICN/DCN
  • If the claim is Primary or MSP
  • Details on paid line items:
    • DOS
    • The procedure code and modifiers
    • Primary diagnosis code
  • Details on denied line items:
    • DOS
    • Denial description from remit

When there is more than one claim on file, the caller says "Next" to hear the next one.

NMP

"What is the X for this claim?"

NMP starts by sharing the following information:

  • The Claim Control Nunber: (ICN or DCN)
  • DOS
  • Claim status
  • Total billed amount
  • Finalized date
  • Electronic Funds Transfer (EFT)/check number
  • Total paid amount

Click on "view claim details" for extra information.

  • DOS
  • Allowed amount
  • Claim finalized date
  • Referring provider NPI
  • Rendering provider NPI and PTAN
  • Billing NPI and PTAN
  • Group specialty code
  • Total deductible
  • Place of service code
  • Claim receipt date
  • If the claim processed MSP (Y or N)
  • MSP type (if applicable)
  • If the claim crossed over (Y or N)
  • Tax identification number
  • Diagnosis code submitted
  • Line item details:
  • DOS
  • Procedure code and modifiers
  • Units
  • Dx pointer
  • Detail billed, allowed, and paid amounts
  • Remittance reason codes and descriptions

 

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
Remittance Advice

"What is the X for this claim?"

Remittances share the following:

  • Finalized date
  • Check number
  • Beneficiary's name, and Medicare ID
  • Patient account number when submitted
  • ICN
  • Assignment (Y or N)
  • Rendering NPI
  • DOS
  • Place of service
  • Units billed
  • Individual billed, allowed, and paid amounts
  • Deductibles
  • Coinsurance
  • Procedure codes and modifiers
  • Reason codes, and remark codes
  • Name of supplement when crossed over
  • Interest paid when applied
  • Patient responsibility

The end of remits will share all financial totals, other adjustments like offsets, and a glossary to describe the reason and remark codes.

 

Last Updated Dec 31, 2018