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Advance Beneficiary Notice of Noncoverage (ABN) - View an ABN overview, medical necessity, triggering events, tips, key points and resources

Appeals - If dissatisfied with an initial claim determination, you have the right to request an appeal. There are many appeal levels and each level must be processed before proceeding to the next. View details

Claims - Access the CMS-1500 instructions and tutorial and view other claim submission related information

Clinical Trials - View information on the different clinical research studies, Medicare coverage for those types, as well as billing guidance and scenarios and solutions

Compliance Program -  View overview of Medicare compliance program requirements

Documentation Requirements - View checklists to help providers submit appropriate documentation to Medicare

Drugs, Biologicals and Injections - View guidance on drugs, biologicals and injections

Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) - Access the Noridian DME Homepages, Latest Updates, contact information, Local Coverage Determinations (LCDs) and articles and Jurisdiction Lists

Electronic Data Interchange (EDI) - Connect with EDI regarding electronic claim submissions

Emergencies and Disasters - In the event of a national or regional catastrophe or disaster, view resources

Fraud & Abuse - View information regarding fraud, abuse, and the related process to report potential concerns

Incentive Programs - View variety of CMS programs with financial incentives for providers

Incident To - View criteria, terminology, direct supervision, direct personal supervision, employment and billing information

Medicare Beneficiary Identifier (MBI) - Congress requires CMS to remove Social Security Numbers (SSNs) from all Medicare cards by April 2019. A randomly generated MBI will replace SSN-based Health Insurance Claim Number on new Medicare cards. View details

Medicare Secondary Payer (MSP) - View general MSP related information, informaiton on Benefits Coordination & Recovery Center (BCRC), billing electronically, payment examples and access the payment calculator

Modifiers - Modifiers can be two digit numbers, two character modifiers, or alpha-numeric indicators. View details

Non-Covered Services - View the differences between not medically necessary services/items and those statutorily excluded.

Noridian Medicare Portal (NMP) - Access General, Registration, End User, and Administrator function related guides and details

Observation - Observation vs inpatient. View decision making scenerios and related reference guides

Overpayment and Recoupment - Overpayment: Repayment, interest rates, and types. Recoument: Request an immediate recoupment, repond to demand letter and submit a voluntary refund. View details

Preventive Services - Medicare pays for many preventive services to keep beneficiaries healthy. View details

Remittance Advice (RA) - View/ access RA related information. Qualified Medicare Beneficiary (QMB) Program, Reason Code guidance, WPC reason and remark codes

Telehealth - Beneficiaries are eligible for telehealth services only if they are treated at an originating site located either in a rural health professional shortage areas (HPSA) or in a county outside of a Metropolitan Statistical Area (MSA). View details
 

Last Updated May 14, 2018

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