Claims processed by Noridian, as the A/B MAC or DME MAC, will not cross over to the pilot for processing. Medicare providers, as a courtesy to the beneficiary, may file claims on the beneficiary's behalf.
Claims that are denied or reduced by other Medicare contractors (not Noridian) , i.e., regional home health and hospice intermediaries, fiscal intermediaries, carriers or Medicare Administrative Contractors, for beneficiaries eligible under this pilot can be submitted to Noridian for processing.
The claim denial cannot be an unprocessable denial or a claim Returned to Provider. The claim must complete processing by Medicare Fee-for-Service before being submitted to the pilot for consideration.
Claims must be submitted within one calendar year from the date of service.
Providers and suppliers should mail or fax a copy of the claim, notice of Medicare payment, and corresponding medical records using the address and fax number below:
The following items are examples of medical records that must be submitted with a claim (not all-inclusive):
The beneficiary will be notified in writing of the payment or denial decision made under the pilot. If the claim is not paid in full, the claim can be appealed. See the Providers/Suppliers Appeals section of this website for the appeals process.