End User Manual for the Noridian Medicare Portal

MBI Lookup Tool

The Medicare Beneficiary Identifier (MBI) Lookup Tool is an option for providers/suppliers if they are not able to obtain the MBI from the patient. For complete instructions, view the MBI Lookup Tool page.

Eligibility

View a beneficiary's Medicare eligibility: Part A, Part B, Managed Care Organization (MCO) and Health Maintenance Organization (HMO), Medicare Secondary Payer (MSP), Home Health, Hospice, End Stage Renal Disease (ESRD), Preventive Services and Medicare Diabetes Prevention Program (MDPP).

When entering information in the inquiry screens, copy and paste functionality may cause extra spaces to be entered. In this case, the portal will state the beneficiary information is invalid. Ensure no extra spaces are entered.

Inquiry

  • Choose Tax Identification Number (TIN) or Social Security Number (SSN), National Provider Identifier (NPI) and Provider Transaction Access Number (PTAN) combination under Provider/Supplier Details
  • Complete mandatory fields (Medicare Number and Last Name) and enter beneficiary's first name and/or date of birth. The name must be entered as shown on beneficiary's Medicare card. Complete optional details to narrow search

You can either enter a custom date range for your inquiry, todays date, or select the option to search 12 months in the past and 4 months in the future. HETS allows transactions 12 months in the past and four months into the future so Noridian suggests entering that date span. That'll give all of the results for the past year and the next few months instead of only the current date.

This image shows the Eligibility Benefits Inquiry on the Noridian Medicare Portal.

Response

The HIPAA Eligibility Transaction System (HETS) is considered the authoritative source for beneficiary Part A and B effective and termination, demographic, MCO and HMO, and ESRD data. For CMS purposes, authoritative source means the data originates here and is shared with other systems. View more information on HETS on the CMS website.

If the beneficiary is enrolled as a Qualified Medicare Beneficiary (QMB), a green banner will display this.

This image shows the QMB verbiage in the Noridian Medicare Portal.

Each tab provides specific information.

Field Name Description
Eligibility
  • Part A and B Effective and Termination Dates
  • Deductible Information
  • Ineligible Period (Due to classified as unlawfully present, deported or incarcerated)
  • Beneficiary Address
  • Occupational, Physical and Speech Therapy
  • Blood Deductible
  • Part D Enrollment Data
Health Maintenance Organization (HMO) and Managed Care Organization (MCO)
  • Insurer Name
  • Policy Number
  • MCO PBP Plan Number
  • MCO PBP Plan Name
  • Effective and Termination Date
  • MCO Plan Type
  • MCO Bill Option Code
  • Address and Phone Number
  • Contract Web Site
Medicare Secondary Payer (MSP)
  • Insurer Name
  • Policy Number
  • MSP Diagnosis Code (if applicable)
  • Effective and Termination Dates
  • Insurer Type
  • Address
Home Health Episode History (HHEH)
  • Payer Name and ID
  • Provider Number
  • Episode Start and End Dates
  • Earliest and Latest Billing Dates
Hospice
  • Provider Number
  • Episode Effective and Termination Dates
Hospital/Skilled Nursing Facility (SNF)
  • Billing NPI
  • From and To Date
  • Bill Type
  • Admittance and Discharge Date
  • Patient Status
End Stage Renal Disease (ESRD)
  • Coverage Start and End Dates
  • Dialysis Start and End Dates
  • Transplant Effective Date
Preventive
  • Smoking Cessation Benefit Information
  • Pulmonary, Cardiac and Intensive Cardiac Rehabilitation Services
  • Preventive Services Benefit Information
    • HCPCS Code
    • Description
    • Next Eligible Date
Medicare Diabetes Prevention Program (MDPP)
  • MDPP Active and Inactive Period
  • MDPP Deductible Period
  • MDPP Coinsurance Period
  • MDPP Preventive Services
    • Code/Modifier
    • Description
    • Next Eligible Date
    • Rendering NPI

 

Claim Status

View the status of claims, view Medical Review comments and initiate a reopening or redetermination on finalized claims.

When entering information in the inquiry screens, copy and paste functionality may cause extra spaces to be entered. In this case, the portal will state the beneficiary information is invalid. Ensure no extra spaces are entered.

Inquiry

  • Choose the TIN or SSN, NPI and PTAN combination under Provider/Supplier Details
  • Complete the mandatory fields in the Beneficiary Details section
  • Complete optional fields to narrow the search
    • Entering a from and to date for the date of service is suggested to narrow the results

Entering a date of service is suggested to narrow the number of results.

This image shows the Claims Status Inqiury screen on the Noridian Medicare Portal.

Response

Select the "View Claim" link to receive additional claim information.

Information received should match the Interactive Voice Response (IVR) system. Consult the Provider Contact Center if information returned is not as expected.

The Noridian Medicare Portal will display all diagnoses submitted on a claim and identifies which diagnosis was indicated as the primary diagnosis per claim line.

This image shows the Claim Status Response screen on the Noridian Medicare Portal.

The following table provides the field name and the description of the field.

Field Name Description
Internal Control Number (ICN)
  • Unique number assigned to claim when received by contractor
  • Used to track and monitor claim
Status Status of claim, e.g. finalized or pending
Billed Amount Total charges submitted
Finalized Date Date when claim finalized processing
Provider Paid Amount Total amount paid to provider
Specialty Physician Specialty Code of the provider who billed the claim
Total Deductible Dollar amount applied to beneficiary's deductible
Receipt Date Date claim was received
MSP Indicator
  • "Y" indicates Medicare is secondary payer
  • "N" indicates Medicare is primary payer
Crossover Indicator
  • "Y" indicates claim is a crossover claim
  • "N" indicates claim is not a crossover claim
Crossover claims are automatic electronic transfer of payment information on finalized claims to supplemental insurance companies and Medicaid that have signed up for the crossover process
Last Worked Date Date the last time claim was examined
Check/EFT#
  • Number on check issued for payment
  • If Electronic Funds Transfer (EFT) was used for payment, this field displays trace number
Line Service line number
From DOS Beginning date of service (DOS) for the claim billing period
To DOS End date of service for the claim billing period
HCPCS Healthcare Common Procedure Coding System (HCPCS) codes
Modifier Code that adds specification to HCPCS categorization
Units Number of units billed on the claim
POS Place of Service (POS) code
Diagnosis Code
  • First code displayed is ICD-9-CM code describing principal diagnosis
  • Remaining codes correspond to additional diagnosis billed on the claim
Billed Amount Dollar amount billed for this line item
Allowed Amount Total amount allowed for line item
Provider Paid Amount provider was paid
Reason Code National administrative code set that identifies reasons for any differences or adjustments between original provider charge and payer's payment

 

Claim Processing Comments

The portal offers access to view claim processing comments if a claim had been selected for prepayment review in which Noridian requested documentation prior to making a claim decision. In the event a claim was not developed for documentation, this option will not be presented.

First, perform a Claim Status Inquiry as described above.

If the claim has a history of being reviewed for additional documentation, the portal will offer a "Noridian Comments" link in the claim header.

This image shows where the Noridian Comments link is located on the Noridian Medicare Portal.

After selecting this link, the claim processing comments will be retrieved and presented.

Claim Processing Comments are displayed.

Note: Protected Health Information (PHI) is not included in the Noridian examiner's comments.

There may be a rare occasion where a claim's history does not have comments associated with it; however, the portal might offer the "Noridian Comments" feature. In this situation, a message will be displayed indicating comments are not available.

Related Claim Details

The portal offers Part B providers access to gain more information about a finalized claim that was denied or received a reduced payment due to related services. Types of claim situations providers can research include National Correct Coding Initiative edits, pre- or post-operative care following a service that had a global period, and/or duplicate claims.

First, perform a Claim Status Inquiry as described above. Select the desired claim.

If the finalized claim processing history reflected the claim was denied or partially reduced due to a previously processed claim, a Related Claim Details link is offered in the claim header.

This image shows where the Related Claim Details link is located on the Noridian Medicare Portal.

After selecting this option, the details of the related claim are presented. If the claim was billed by a different group PTAN, the date or service, rendering provider name and the billing provider's phone number will display. If the claim was billed by the same group PTAN, the ICN and remittance advice date will also be displayed.

Related Claim Details response is displayed.

Expanded Denial Details

NMP provides expanded denial details in Claim Status Results. This allows access to important denial details.

Go to the Expanded Denial Details section of the User manual to view further instructions.

Self Service Reopenings

A self-service reopening is submitted by performing a Claim Status inquiry first. The Self-Service Reopening link is located under Related Inquiries. For full instructions, view the Self-Service Reopenings page.

Additional Documentation Request

If an ADR was sent to the supplier and the claim is pending, suppliers may view the letter and submit supporting documentation.

Go to the Additional Documentation Request Submission and Status section of the User Manual to view further instructions.

Financial Information

View pending and finalized check information issued to an NPI/PTAN combination.

Inquiry

  • Select Financial from top navigation or home page and then Payment Results tab
  • Choose TIN or SSN, NPI and PTAN combination under Provider/Supplier Details

Financial Payment Results inquiry

Response

The portal provides the most recent 50 checks and the following:

  • Number of pending claims and dollar amount
  • Number of claims approved-to-pay and dollar amount
  • Number of claims paid month-to-date and dollar amount
  • Number of claims paid year-to-date and dollar amount

Select a check number will provide a link to view the Full Remittance Advice.

1099 Inquiry

The 1099 Inquiry allows users to download a PDF copy of their facilities 1099-MISC and/or 1099-INT tax forms issued by Noridian.

Note: The 1099 portal forms are not replacing the hard-copy mailed forms your facility will still receive. These forms are a final copy and will not be corrected if any updates are made. Corrected forms will be mailed to the facility if necessary.

Inquiry

  • Select Financials from the top navigation or home page and then choose the 1099 tab.
  • Choose TIN, NPI, PTAN and Program under Provider/Supplier Details
  • Choose the Financial Year
    • As of December 14, 2018, the 2017 returns will be available. The 2018 returns will be made available by January 31, 2019.

This screen shows the 1099 Inquiry.

Response

The results will display the 1099 forms applicable to the Tax ID used for the inquiry.

This image shows the 1099 inquiry results screen.

Note: Your facility may only have one Type of Return depending on the type of payments that were issued from Noridian for that financial year.

Appeals Status Inquiry

Noridian processes reopening and redetermination requests within 60 days of receipt.

Inquiry

To check the status of a reopening or redetermination, select the TIN or SSN, NPI and PTAN it was submitted under and select one of the following options:

  • Option 1 - View Last 100 Appeals
  • Option 2 - Search Existing Appeals
    • Medicare Number
    • Appeal Status (Pending, Finalized, Additional Documentation Needed)
    • Confirmation Number

This image shows the Appeals Status Inquiry screen on the Noridian Medicare Portal.

Response

The results will display the confirmation number, claim number, Medicare Number, status and date submitted. To view more information on the request select View Appeal. A list of the submitted documentation displays. To view the document, select View Document. If additional documentation is needed, select "Add a Document".

The decision letter from Appeals is available to view when the request is finalized. Letters are only available for partially favorable and denied appeals. Providers are notified of favorable decisions through the remittance advice.

This screen shows the Appeals Status Results screen on the Noridian Medicare Portal.

Begin New Appeal

A new appeal can also be submitted by performing a claim status inquiry and following the same steps. Access the CMS "Transfer (Assignment) of Appeal Rights" form from the Appeal Forms webpage.

Inquiry

  • Choose TIN or SSN, NPI and PTAN combination under Provider/Supplier Details
  • Complete mandatory fields in Beneficiary Details section. Complete optional fields to narrow search.

This image shows the Begin New Appeal screen on the Noridian Medicare Portal.

Response

The results will display based on the criteria entered. To begin the appeal choose View Claim.

Additional claim details are provided. To begin the appeal choose the Redetermination/Reopening Submission button.

Reopening or Redetermination Request Form

The Reopening or Redetermination Request form displays. User sessions time out after 30 minutes of inactivity. Ensure all information is gathered prior to beginning the request. There are four steps to complete an appeal.

Redetermination/Reopening Details

The claim details are provided and the following questions are asked:

  • Type of Request – Redetermination or Reopening
  • Will a review of this claim cause an overpayment?
    • If answered yes, users are prompted to request a recoupment. The appeal process will not continue.

Reopening and Redetermination form is displayed.

  • Is this request the result of an overpayment?
    • If answered yes, users are asked who initiated the overpayment (Benefit Integrity, Comprehensive Error Rate Testing (CERT), Medical Review, Office of Inspector General (OIG), Recovery Auditor, Supplemental Medical Review Contractor (SMRC) or Unified Program Integrity Contractor (UPIC). The Accounts Receivable (AR) Number is then required. The AR number is found on the overpayment letter from Noridian.

Appeals form Submission Details are displayed.

  • The contact person (portal user submitting the request) information is also displayed. Address information is requested on an appeal, however, this information is not required.

Appeals form Contact information is displayed.

  • Next, providers will enter the claim details and an explanation as to why the appeal is being submitted and any other information is needed for the appeal.

Appeals form details and explanation are displayed.

  • In the Claim Status Line Details section, users must check the box next to the line item the reopening or redetermination is being requested on. Note: Checking all will initiate an appeal on all lines regardless of whether they are paid or denied. This may result in a loss of further appeal rights.

Appeals form claim status line details are displayed.

  • Select Next.

Electronic Signature (Optional)

A signature is optional on a Reopening/Redetermination submission. If you choose to sign the appeal, enter your name and check the box and choose Submit or select "Skip this Step".

This image shows the options to submit the appeal with a signature or to skip this step without a signature.

Add Documents

To attach documentation, select the "Add Document" button. Title the document so it is recognizable when reviewing the submission and browse to locate it. Numerous documents may be added during this step. If more than one file is needed to be uploaded, select the "Add Document" button again to add another file. Once this is completed, select the Next button. If a document needs to be removed, select the Delete link in the last column.

Reopening and Redetermination form add documents screen is displayed.

Confirmation

Step 4 displays a successful upload message and show the appeal information below. To add additional documents, choose the "Add Document" button on the bottom of the screen.

In the event a provider has submitted a reopening/redetermination and he/she wants to delete/dismiss, a document explaining the dismissal/deletion needs to be created on company letterhead and must contain an original, "pen and ink" true signature. This dismissal request needs to be uploaded as an attachment to the existing appeal.

Full Remittance Advices (RAs)

Users may view, save and print full RAs.

Inquiry

  • Select "Remittance Advices" from Main Menu and then "Full Remittance" tab
  • Choose TIN or SSN, NPI, PTAN and Program (if applicable) under Provider/Supplier Details
  • Select one of the following options
    • Option 1 - View remittances issued within last 30 days
    • Option 2 - Narrow search results down by a specific date range, check amount, or check number

This image shows the Full Remittance Advices inquiry screen

Reminders:

  • Do not use a dollar sign or comma when entering a check amount
  • No-pay RAs can be found by entering 0.0 in Check Amount
  • For either search option, NMP will display most recent 100 RAs

Response

Based on the inquiry criteria, the results will display. The results will include the date issued, check number, check amount and the number of pages.

To view the RA in a PDF format, select View PDF. The RA can be saved and printed. RAs large than 1,000 pages will not be viewable in NMP.

This image shows the Full Remittance Advice results page

Claim-Specific Remittance Advices

View and/or print a remittance advice information for a single claim.

Inquiry

  • Select Remittance Advices from home page
  • Choose TIN or SSN, NPI and PTAN combination under Provider/Supplier Details
  • Enter Claim Number
    • To view patient information for a Withholding (WO), enter the 15-digit Financial Control Number (FCN) included on full Remittance Advice with first two digits removed

This image shows the Claim Specific Remittance Advice inquiry screen on the Noridian Medicare Portal.

Response

A copy of the claim-specific remittance advice displays. To print the claim-specific remittance advice, select "Printable Version" in the upper left corner. (The information that appears on this screen will vary depending on the claim). Definitions of remark and reason codes are provided at the bottom of the screen.

This image shows the Claim Specific Remittance advice response.

Send Us a Message

Users may send Noridian a secure message regarding claims that have been reviewed by CERT or the Noridian Medical Review teams. These messages may be about a claim determination, information on education and prior authorization or other concerns.

Go to the Send Us a Message section of the User Manual to view further instructions.

NMP Browser Compatibility

The Noridian Medicare Portal is accessible from several different web browsers; however, only certain browsers are supported. View the list below to determine the browser requirements for using the portal. Using older browsers, non-compatible browsers, or disabling browser features such as JavaScript, may result in reduced functionality.

Supported Browsers

Providers can check their browser version by going to the Help menu and selecting "About...." A screen will appear showing which browser and version is being used.

The Noridian Medicare Portal is best viewed when the display resolution is set to 1024 x 768 or above. If the settings are below 1024 x 768, additional scroll bars will be encountered.

Support Contact Information

Have the following information available: User name and/or email address, NPI/TIN/PTAN

  • User Security is available to assist providers with questions regarding registration, logging in to the portal, technical difficulties with availability or functionality, and password reset requests.
  • Customer Service is available to assist with any questions you may have regarding the results of the inquiry response.

Other Contacts

Providers and beneficiaries may need to call other contractors in order to update or inquire on the information provided in the eligibility function of the portal.

  • Beneficiary Call Center - 1-800-MEDICARE (1-800-633-4227)
  • Coordination of Benefits - 1-855-798-2627
  • Home Health - To update information, beneficiary must contact Home Health Agency
  • Social Security Administration (SSA) - To update information, beneficiary must contact SSA at 1-800-772-1213

Security Awareness Training and Recertification

  • Security Awareness Training - Security Awareness Training occurs upon the first login and will occur on a yearly basis in conjunction with the recertification. The process will be initiated 45 days prior to the last day of the month in which the users account was initially setup. This training must be completed in the 45 day period in order to continue using the portal. If this training is not completed in this timeframe, the user's account will be disabled and the user must contact Noridian Medicare Portal Support in order to unlock it. Upon logging in again, the user will be prompted to complete the training. If the training is not completed within 90 days, the user's account will be deleted and the user must re-register.
  • Recertification - Portal users will be prompted to recertify accounts on a yearly basis. This recertification demonstrates the Noridian Medicare Portal account is being used by the appropriate person. The process will be initiated 45 days prior to the last day of the month in which the users account was initially setup. The recertification must be completed in the 45 day period in order to continue using the portal. If the account is not recertified within the timeframe, the user's account will be disabled and the user must contact Noridian Medicare Portal Support in order to unlock it. Upon logging in again, the user will be prompted to recertify the account. If it is not recertified in 90 days, the user's account will be deleted and the user must re-register.

 

Last Updated Oct 04, 2019