Unlisted Procedure Reimbursements with Noridian
Paula Rogerson-Doherty
Description
Collection
Title:
Unlisted Procedure Reimbursements with Noridian
Creator:
Paula Rogerson-Doherty
Date:
1/3/2022
Text:
Hello,
Wondering if any other providers are experiencing problems with Noridian pricing Unlisted procedure codes and suggestions on who to address this to?
We have recently had claims coming back with payments of less than the invoice charge we submitted from the manufacturer.
I am not referring to MSRP but actual invoice for a specific feature/product that gets classified as a 999 code.
The codes were covered under reconsideration based on Medical Necessity but I have never had these issues where we weren't at minimum reimbursed the invoice charge from manufacturer.
We are now being instructed to submit second level appeal to review the pricing - the pricing should have been appropriately addressed on the first appeal.
I do appreciate the frustration of 999 codes and am not looking for a debate about using them or not but am looking to see if anyone else has had to address this matter or if anyone has suggestions of whom to contact on a higher level to discuss the problem? IC formula's with other insurers are not perfect but at least you get your material costs covered, Noridian isn't even covering the material cost.
Any experience or suggestions on addressing this problem are appreciated.
I would love to know if anyone has any good contacts at Noridian who actually try to help versus customer service response of submit another appeal.
Thank you
Paula Rogerson-Doherty
Business & Administrative Manager
Rogerson Orthotics & Prosthetics
P: (617) 268-1135
F: (617)269-3373
<URL Redacted> < <URL Redacted> >
Confidentiality Notice: This email, including attachments, is covered by the Electronic Communications Privacy Act, 18 USC 2510-2521, and the HIPAA privacy regulations and, as such, is confidential and may be legally privileged. It is intended for the use of the individual or entity to which it is addressed and may contain certain information that is privileged, confidential, and exempt from disclosure under applicable law. If the reader of this email is not the intended recipient or agent responsible for delivering or copying this communication and attachments, you are hereby notified that any retention, dissemination, distribution, or copying of this communication is strictly prohibited. Please reply to the sender that you received it in error, then delete it. Thank you for your cooperation.
Wondering if any other providers are experiencing problems with Noridian pricing Unlisted procedure codes and suggestions on who to address this to?
We have recently had claims coming back with payments of less than the invoice charge we submitted from the manufacturer.
I am not referring to MSRP but actual invoice for a specific feature/product that gets classified as a 999 code.
The codes were covered under reconsideration based on Medical Necessity but I have never had these issues where we weren't at minimum reimbursed the invoice charge from manufacturer.
We are now being instructed to submit second level appeal to review the pricing - the pricing should have been appropriately addressed on the first appeal.
I do appreciate the frustration of 999 codes and am not looking for a debate about using them or not but am looking to see if anyone else has had to address this matter or if anyone has suggestions of whom to contact on a higher level to discuss the problem? IC formula's with other insurers are not perfect but at least you get your material costs covered, Noridian isn't even covering the material cost.
Any experience or suggestions on addressing this problem are appreciated.
I would love to know if anyone has any good contacts at Noridian who actually try to help versus customer service response of submit another appeal.
Thank you
Paula Rogerson-Doherty
Business & Administrative Manager
Rogerson Orthotics & Prosthetics
P: (617) 268-1135
F: (617)269-3373
<URL Redacted> < <URL Redacted> >
Confidentiality Notice: This email, including attachments, is covered by the Electronic Communications Privacy Act, 18 USC 2510-2521, and the HIPAA privacy regulations and, as such, is confidential and may be legally privileged. It is intended for the use of the individual or entity to which it is addressed and may contain certain information that is privileged, confidential, and exempt from disclosure under applicable law. If the reader of this email is not the intended recipient or agent responsible for delivering or copying this communication and attachments, you are hereby notified that any retention, dissemination, distribution, or copying of this communication is strictly prohibited. Please reply to the sender that you received it in error, then delete it. Thank you for your cooperation.
Citation
Paula Rogerson-Doherty, “Unlisted Procedure Reimbursements with Noridian,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 1, 2024, https://library.drfop.org/items/show/255743.
