Each of the DME MACs have created webpages that offer podiatrists and other DME suppliers access to useful Medicare information. The “Portals” requires individual registration and uses a personal log-in. They offer different levels of accessibility and also protects patient personal health information. Presently Jurisdictions A and D are serviced by Noridian; Jurisdictions B and C are serviced by CGS.
Podiatrists are encouraged to register for the Portals corresponding to the region(s) where their patients reside and to also create access for appropriate staff members. Some of the things that are certain to prove useful include: Medicare Beneficiary Identifier (MBI) lookup, info about the Interactive Voice Response (IVR) for checking status of claims, and redetermination.
Noridian Medicare Portal (NMP)
Jurisdiction A, Jurisdiction D.
https://www.noridianmedicareportal.com/web/nmp/home
CGS Medicare Portal (myCGS)
Jurisdiction B, Jurisdiction C.
https://www.cgsmedicare.com/jc/mycgs/pdf/mycgs_registrationguide.pdf
Medicare Beneficiary Identifier (MBI) Look Up Tool
A new Medicare Beneficiary Identifier (MBI) replaced the SSN-based Health Insurance Claim Number (HICN) on the new Medicare cards for Medicare transactions like billing, eligibility status, and claim status.
In the past, the HICN was based on a person’s social security number. Every person with Medicare has been assigned an MBI and has been mailed a new Medicare card. The MBI is confidential like the SSN and should be protected as Personally Identifiable Information. The biggest reason for the new MBI is to fight medical identity theft for people with Medicare.
The MBI provides podiatrists and other DME suppliers information need to enter using the telephone key pad when using the IVR and is based only on the information you enter.
Use this tool to convert the patient’s MBI to the corresponding numbers on your telephone key pad.
https://cgsmedicare.com/medicare_dynamic/jb/mbiconverter.aspThe Medicare Beneficiary Identifier (MBI) Lookup Tool is an option for providers/suppliers if they are not able to obtain the MBI from the patient.
Noridian DME: Jurisdiction A, D
https://med.noridianmedicare.com/web/jadme%20/topics/nmp/end-user-manual/mbi-lookup-tool
CGS: Jurisdiction B, C
https://cgsmedicare.com/parta/pubs/news/2018/05/cope7584.html
Medicare Interactive Voice Response (IVR)
The Centers for Medicare & Medicaid Services (CMS) requires providers to utilize the Interactive Voice Response (IVR) System to check the status of claims. The Interactive Voice Response (IVR) system requires you to enter your patient’s name and Medicare number during the beneficiary validation process. The IVR will validate the beneficiary information.
Noridian: Jurisdictions A, D
https://med.noridianmedicare.com/web/jeb/contact/ivr
CGS: Jurisdictions B, C
To use the IVR, please call: 877.299.7900
Submitting Redeterminations Through the Medicare Portal
When AFO claims are denied and given reason code “M3”, it’s because of “Same or similar”, meaning that Medicare is only covering one device, prefabricated or custom, per side, every five years. Claims to treat a different diagnosis with a different device, can generally be covered, even after initial denial, if appealed as a “Redetermination”. Redetermination can be done either by faxing in a form and supporting documentation or via the Portal. Its recommended that suppliers use the Portal, and not fax, as it provides assurance that all forms are received.
Noridian: Jurisdictions A, D
https://www.noridianmedicareportal.com/
CGS: Jurisdictions B, C
https://cgsmedicare.com/articles/cope25316.html
Documentation Identification Tool
CGS has created the Documentation Identification Tool to assist you in submitting the different types of documentation needed to support your claim. Simply select the type of documentation you are submitting from our list of items below. Then print the pre-designed divider sheet and place it in front of the document(s) that will be submitted for review.
The documentation identification tool standardizes the process so you no longer need to create your own divider sheets for your documentation.
https://www.cgsmedicare.com/jc/help/documentation_identification_tool.html
Jurisdiction A is serviced by Noridian Healthcare Solutions and includes Connecticut, Delaware, District of Columbia, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island and Vermont.
Jurisdiction B is serviced by CGS and includes Illinois, Indiana, Kentucky, Michigan, Minnesota, Ohio and Wisconsin.
Jurisdiction C is serviced by CGS and includes Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas, Virginia, West Virginia and the US Virgin Islands.
Jurisdiction D is serviced by Noridian Healthcare Solutions and includes Alaska, American Samoa, Arizona, California, Guam, Hawaii, Idaho, Iowa, Kansas, Missouri, Montana, Nebraska, Nevada, North Dakota, Northern Mariana Islands, Oregon, South Dakota, Utah, Washington and Wyoming,