Claim Status

On this page, view the below information.

Claim Status Inquiry

Available For: Part A, Part B, DME

View the status of claims, Medical Review comments and initiate a redetermination on finalized claims using the Claim Status tab.

Inquiry

  • Go to Claim Status from the main menu and the Claim Status Inquiry tab
  • Enter the required Beneficiary Details fields.
    • Medicare Number
    • First and Last Name
    • Date of Birth

Claim Details may be entered to narrow search results:

  • From and To Date
  • Total Charges/Billed Amount
  • ICN/DCN/CCN
  • Bill Type/Specialty
  • CPT/HCPCS
Tip Entering From and To Dates are suggested to narrow the number of results.

Response

The claims that match the search criteria are displayed. 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 following table provides the field name and a description of the response details.

Field Name Description
ICN/DCN/CCN Unique number assigned to claim by contractor used to track and monitor claim
Status Status of claim (Ex. Pending or Finalized)
Billed Amount Total charges submitted
Finalized Date Date claim completed adjudication process
Provider Paid Amount Total amount paid to provider
Referring Provider Individual who directed patient for care
Rendering NPI Physician who provided the services
Rendering PTAN Physician who provided the services
Specialty Physician Specialty Code
Total Deductible Dollar amount applied to beneficiary's deductible
Place of Service Facility or location where services are provided
Receipt Date Date claim was received by Noridian
MSP Indicator
  • "Y" indicates Medicare is secondary payer
  • "N" indicates Medicare is primary payer
MSP Type Insurance type code
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 agreements.

Last Worked Date Date the last time claim was examined
Check/EFT# Number on check issued for payment

 

The Noridian Medicare Portal displays all diagnoses submitted on a claim. Diagnosis codes indicated as the primary diagnosis per line item on a claim will also display. The admitting diagnosis will also display if it was entered on the claim.

The Claim Status Line Details table contains the following information:

Field Name Description
Date of Service Beginning and End Date of Service
Procedure Code Current Procedural Terminology (CPT) Codes
Modifier Code that adds specification to HCPCS code
Units Number of Units for service
Diagnosis Pointer Applicable diagnosis pointer
Billed Amount Amount billed for service line
Allowed Amount Total amount allowed for service line
Provider Paid Amount provider was paid
Reason Code National administrative code that identifies reasons for any difference or adjustments between original provider charge and payer's payment

 

If the claim had an Additional Documentation Request (ADR) sent by Noridian, the details of that ADR will display as well. To respond to the ADR, go to the ADR section of the user manual.

 

Claim Processing Comments

Available For: Part A, Part B, DME

NMP 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.

Perform a Claim Status Inquiry as described above.

If the claim had a history of being reviewed for additional documentation, the portal will offer a "Noridian Comments" link in the claim header under Related Inquiries. If the claim was not suspended during processing, this option will not be presented.

After selecting this link, the claim processing comments will be retrieved and presented at the bottom of the Claim Status details.

Tip Protected Health Information (PHI) is not included within the Noridian comments.

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

 

Related Claim Details

Available For: Part B

NMP allows 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.

Perform a Claim Status Inquiry as described above and 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 will display in the claim header under Related Inquiries.

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, Date of Service, Date of Remit, Rendering Provider Name and Billing Phone Number are provided.

 

Expanded Denial Details

Available For: Part A, Part B, DME

NMP provides claim denial details for the below claim denials. This will allow access to important details without a separate eligibility inquiry.

  • Medicare Secondary Payer (MSP) Denial Details
  • Medicare Advantage/Health Maintenance Organization (HMO) Denial Details
  • Eligibility Denial Details
  • Date of Death Denial Details
  • Hospice Denial Details
  • Home Health Denial Details
  • Overlap Denial Details
  • Patient Status Denial Details
  • Skilled Nursing Facility/Inpatient Denial Details
  • Alien and Incarcerated Denial Details
  • End Stage Renal Disease Denial Details

You will first perform a Claim Status Inquiry and view the desired claim.

In the Related Inquiries section, a link for the applicable denial details will display.

Tip If an error message stating "Your inquiry cannot be performed at this time" occurs, the patients file could have been updated after the claim has processed. If further assistance is needed, contact the Provider Contact Center.

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MSP Denial Details

MSP Denial Details will display the following:

  • Insurer Type
  • Insurers Name
  • Address
  • Policy Number
  • Effective and Term Date

In the Resources section the Phone Number for any BCRC updates, IOM references and references to the Noridian MSP topic page are provided.

HMO Denial Details

HMP Denial Details will display the following:

  • Start and End Date
  • Plan ID
  • Plan Name and Address

To update the status of the HMO, the beneficiary or legal representative must contact the plan.

Eligibility Denial Details

Eligibility Denial Details will display the following:

  • Part A Entitlement and Termination Dates
  • Part B Entitlement and Termination Dates

To update their entitlement, the beneficiary or legal representative must contact the Social Security Administration (SSA).

Date of Death Denial Details
  • Date of Death Denial Details will display the following:
  • Date of Death on file in the Social Security Administration (SSA) record

To update the record, the beneficiary or legal representative must contact the SSA. In the resources section the portal provides a CMS link as a reference.

Hospice Denial Details

Hospice Denial Details will display the following:

  • Start and End Date
  • Provider NPI

Links to the NPI Registry and CMS IOM references are provided in the Resources section.

Home Health Denial Details

The Home Health Denial Details will display the following:

  • Form and Thru Dates of the Home Health Plan on File
  • Provider NPI

In the resources section we provide a link to the NPI Registry website and CMS IOM references in the resources section, as well as a CMS link to Home Health Information.

Overlap Denial Details

The Overlap Denial Details will display the following:

  • From and Thru Dates of the Overlap
  • Provider NPI

In the Resources section a link to the NPI Registry website is provided.

Patient Status Denial Details

The Patient Status Denial Details will display the following:

  • From Date
  • Facility Type
Skilled Nursing Facility/Inpatient Denial Details

The SNF/Inpatient Denial Details will display the following:

  • From and Thru Dates
  • Provider NPI
  • Additional Resources
Alien and Incarcerated Denial Details

The Alien and Incarcerated Denial Details will display the following:

  • Start and End Date
  • Additional Resources
End Stage Renal Disease Denial Details

The ESRD/Dialysis Denial Details will display the following:

  • From and Thru Dates
  • Provider NPI
  • Additional Resources

 

Last Updated Mon, 12 Oct 2020 20:21:08 +0000