Palmetto to Noridian: What is the Difference?

If you are a Medicare participating provider in California, Nevada, or the other territories formerly known as Jurisdiction-1B, your Medicare Administrative Contractor (MAC) has changed. Effective September 16th, 2013, Noridian Healthcare LLC Jurisdiction E has taken over the contract for the areas formerly known as Jurisdiction-1B under Palmetto GBA.

What Changes

    • Payer ID  and Claims Address. This is a simple one time update in your system and shouldn’t have an impact on reimbursement.
      Payer ID: 01112 for Northern CA.
      Claims Address:
      Medicare Part B Claims
      P.O. Box 6774
      Fargo, ND 58108-6774
    • How paper claims are edited. Most claims are not billed on paper these days, but all offices have HCFAs on hand for when it is necessary. The edits of paper claims by Noridian differ slightly from Palmetto’s, but enough that they may deny your paper claims and ultimately delay reimbursement.  Noridian has provided a handy guide here, but at the moment of this blog post their website is down and has been for some time. The transition must have been a bit hard on their website’s servers! It gives box by box instruction, so it is worth a visit back when the site is up.
    • New Provider Portal. Obviously, you’ll no longer go to Palmetto’s provider portal unless you’re accessing information for claims submitted prior to the transition. Noridian will use the Endeavor portal, and if you were registered with Palmetto you were automatically enrolled with Endeavor. An email was sent to the email address associated with your account.

What Remains the Same

      • Local Coverage Determinations (LCD). From a claims reimbursement perspective, the fact that the LCDs are unchanged from Palmetto’s is huge. Most of us know the applicable ones for our practice(s) like the back of our hand, or at least where we can find them. Your LCD# will change, but the contents will not.
      • Your EFT, ERA, submitter number. If you are already set up to receive electronic remittances and to submit electronic claims with Palmetto you will not need to reapply with Noridian. You’ll only need to change their claims payor ID (mentioned above).
      • Your status with Medicare. No Re-Validation required!

Questions or comments? Leave them below, or give us a call any time (925)583-5328.

 

 

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