NMP and IVR Eligibility and MBI Elements Comparison

Eligibility 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 Eligibility Provider: Tax ID, NPI, PTAN, Program
Beneficiary: Medicare number, last name, first name or DOB
IVR Option 1 - Eligibility Provider: NPI, PTAN, last five digits of Tax ID
Beneficiary: Medicare number, gender, first and last name, DOB, and DOS

 

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A/B Entitlement Dates

"Does this patient have Medicare Part A/Part B?"

Access Part A or Part B start and term dates.

NMP

  • Eligibility

IVR

  • Option 1 - Eligibility
Date of Death

"Does this beneficiary have a date of death (DOD)?"

If applicable:

NMP

  • Eligibility
    • DOD is indicated below date of birth (DOB) field

IVR

  • Option 1 - Eligibility
    • Request "Eligibility Details"
    • Request 3rd option, "Other"
Deductible

"What is amount remaining on the patient's deductible?"

The remaining amount on a patient's deductible, based on the date of service, can be shared; however, the deductible is not shared when he/she is a Qualified Medicare Beneficiary (QMB).

NMP

  • Eligibility

IVR

  • Option 1 - Eligibility
    • It is provided after Part A and Part B entitlement dates
End Stage Renal Disease (ESRD)

"Is this patient getting ESRD/dialysis care?"

NMP

  • Eligibility
    • Select "ESRD"
      • Effective date
      • Benefit type

IVR

  • ESRD details are not available
Facilities

"Is the patient in an "X" facility?"

Home Health

"Is the patient getting Home Health care?"

Home Health providers, based on the date of service, are available.

NMP

  • Eligibility
    • Select "HHEH"
      • Medicare contractor's name
      • Payer ID
      • Home Health provider's NPI
      • Episode start and end dates
      • Earliest and latest date of billing (DOEBA - DOLBA)

IVR

If there is Home Health on file, the earliest and latest date of billing is available.

  • Option 1 - Eligibility
    • Request "Eligibility Details"
    • Request 3rd option, "Other"
Hospice

"Is the patient in Hospice?"

Hospice providers, based on the date of service, are available. NMP and IVR will not note if a stay is revoked.

NMP

  • Eligibility
    • Select "Hospice"
      • Hospice provider's NPI
      • Occurrence count
      • Effective and term dates

IVR

If there is a Hospice on file, the earliest and latest date of billing.

  • Option 1 - Eligibility
    • Request "Eligibility Details"
    • Request 3rd option, "Other"
Hospital

"Is my patient in a Hospital?"

Hospitals, based on the date of service, are available.

NMP

  • Eligibility
    • Select "Hospital"
      • Earliest and latest billing dates
      • Deductible remaining
      • Full days remaining
      • Lifetime reserve days remaining
      • Lifetime base reserve days remaining
      • Lifetime psychiatric days remaining
      • Part A Spell days remaining
      • Lifetime copay amount per day
      • Lifetime psychiatric base days
      • Copay days remaining
      • Copay amount remaining
      • Part A deductible for the DOS year
      • Hospital Spell dates

IVR

  • Hospital information is not available for Part B providers
Skilled Nursing Facility (SNF)

"Is the patient in a SNF?"

SNF providers, based on the date of service, are available.

NMP

  • Eligibility
    • Select "SNF"
      • Earliest and latest billing date
      • Days remaining
      • Copay days remaining
      • Copay remaining

IVR

If there is a SNF for the DOS, the earliest and latest date of stay is available.

  • Option 1 - Eligibility
    • Request "Eligibility Details"
    • Request 3rd option, "Other"
HMO - Advantage Plans

"Does the patient have an HMO/Replacement plan?"

HMO/MA Plan information is available based on the date of service provided.

  • Is there an HMO
  • HMO name
  • HMO type
  • Plan ID
  • Address, if available
  • Phone number
  • Effective and term date

NMP

  • Eligibility
    • Select "HMO/MCO"

IVR

  • Option 1 - Eligibility
    • Request "Eligibility Details"
    • Request 1st option "Managed Care"
MBI

"What is the beneficiary's Medicare Beneficiary ID (MBI)?"

This tool only works 21 days after the beneficiary's new Medicare card has been mailed to him/her.

NMP Only

User must enter provider and beneficiary information

  • Enter Provider's Tax ID, NPI, PTAN, and Program
  • Enter Beneficiary's First Name, Last Name, DOB, and Social Security Number (SSN)
    • Note: Do not include beneficiary's old Medicare number
  • Enter "I am not a robot" text (Only needed once for every five transactions)
Medicare Secondary Payer (MSP)

"Is Medicare the beneficiary's primary or secondary insurer?"

This MSP information is available based on the date of service provided.

  • Medicare is/is not primary
  • If Medicare is secondary, the below primary insurer details are provided.
    • Insurer name
    • Policy number
    • Effective and term dates
    • MSP Type
    • Address

NMP

  • Eligibility
    • Select "MSP"

IVR

  • Option 1 - Eligibility
    • Request "Eligibility Details"
    • Request 2nd option, "MSP"
Preventive Services

"What is the next eligible date for X?"

The Provider Contact Center (PCC) can assist callers but the next eligible date, for the following procedure codes, may be accessed within NMP.

NMP

Covered Codes.

  • Eligibility
    • Select "Preventive"
      • 77057
      • 80061
      • 82270-26
      • 82270-TC
      • 82465
      • 82947
      • 82950
      • 82951
      • 93718
      • 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
      • P300
      • Q0091-26
      • Q0091-TC
Qualified Medicare Beneficiary (QMB)

"Is this beneficiary dual-eligible/a qualified Medicare beneficiary?"

Access a beneficiary's QMB status.

NMP

  • Eligibility
    • See notice in green before A-B start dates

IVR

  • Option 1 - Eligbility
    • Provided before A-B start dates are given
Therapy Cap

"What's on the patient's Physical or Occupational Therapy Cap?"

Access the amount applied to therapy caps based on the date of service.

NMP

  • Eligibility
    • Select "Eligibility"

IVR

  • Option 1 - Eligibility
    • Request "Eligibility Details"
    • Request 3rd option, "Other"

 

Last Updated Dec 31, 2018