Inquiry Guide

Begin New Appeal

Available For: Part A, Part B, DME

A new appeal can be submitted by choosing Begin New Appeal under the Appeals tab and performing a Claim Status inquiry to find the claim being appealed.

To begin the appeal, choose View Claim and then Redetermination/Reopening Submission under Related Inquiries. The Reopening/Redetermination Form will display.

Reopening/Redetermination Request Form

The Appeals process in NMP is a 4 Step process. Follow the steps below to ensure the form is submitted correctly.

Step 1 - Redetermination/Reopening Details

  • Type of Request - Redetermination or Reopening
  • Will a review of this claim cause an overpayment? - Yes or No
    • If Yes, a message will display stating a recoupment request must be submitted. The appeal process will not continue.
  • Is this request the result of an overpayment? - Yes or No
    • If Yes, the following are required:
      • Who initiated the overpayment? Benefit Integrity, CERT, Medical Review, OIG, Recovery Auditor, SMRC, ZPIC/PSC
      • AR Number - Accounts Receivable Number - Found on the overpayment letter from Noridian.
  • Contact Person information is auto-populated.
  • Provider Address information is requested, but not required.
  • Details and Explanation - Enter claim details and an explanation why the appeal is being submitted and any other information is needed for the Noridian examiner. Be as detailed as possible.
  • Claim Status Line Details - Check the box next to the line item the reopening or redetermination is being requested on.
Tip Using the "Select All" box 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.
  • Select "Next".

Step 2 - 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 attestation box and choose Submit. If you choose not to sign the appeal, choose Skip this Step.

Step 3 - Add Documents

To attach documentation to support the appeal, select the "Add Document" button. Enter a Document Name and Browse for the location of the file. Repeat this step for as many documents as needed. The file size for each upload is 70MB. File types accepted include: .doc, .docx, .xls, .xlsx, .pdf, .bmp, .ppt, .pptx, .gif, .jpeg, .jpg, .png, rtf, .tif, .tiff, .txt, .xml, .dbf and .xxA1. Choose Next once all documentation has been uploaded.

If no documentation is needed to support the appeal, choose "Skip This Step".

As of June 13, 2019, the CMS Transfer of Appeal Rights form may be submitted as documentation.

Step 4 - Confirmation

A confirmation page displays the Appeal information, including the documentation that was submitted. If additional documentation is needed, choose Add Document and complete the upload steps. This page maybe printed off for your records.

Tip If the submitted appeal needs to be deleted or dismissed, a document explaining the reasoning needs to be created on company letterhead and must contain an original "pen and ink" true signature. This dismissal request may be uploaded as an attachment to the existing appeal.

 

Last Updated Mon, 18 Nov 2019 18:42:39 +0000