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Linda Collins Blogger

Additional Information on Denials

Posted by Linda Collins | May 08, 2015

Your claim is audited by the regional DMEMAC. You respond to the request for additional information. You receive a notice of denial. What resources are available to help you understand the denial reasons and be prepared to file an appeal?

Each of the four DMEMAC regions offers a slightly different option for gathering additional information on a specific claim denial. Below are the basic instructions and links to each of the sites.
NHIC, Region A
The “Decision Desktop” option allows you access to specific details about a claim decision. Currently, the tool is limited to those claims denied after a Complex Medical Review of your documents submitted in response to the audit request. The tool is also limited to LSOs delivered after February 15, 2015 and Lower Limb Prosthetics delivered after April 15, 2015.
NGS  Region B
If your denial has ANSI Remark Code N102, N109 (for dates of review after 1/14/2104) or N115 (for dates of review after 1/1/2015)  you can access the “Medical Review Denial Tool” to obtain more specific information about the denial.
CGS, Region C
In addition to gathering more information about a specific claim, the resource offered through Region C allows you to gather information about all denials for a provider within a specific date range. The online resource is called “Mr Wizard” and is available for claims denials dated after June 30, 2014.
Noridian, Region D
Region D does not currently offer an interactive tool for gathering information on a specific claim denial. The Noridian website does offer information about claims denial codes and you always have the option of calling the Supplier Contact Center (877-320-0390.)
Accessing the claims information through online tools will allow you to see the reason for the denial along with specific information about the claim. This information may be helpful to you as you prepare for appeals. Be sure to have the 14-digit CCN when you sign on to the site.
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