Noridian Healthcare Solutions provides administrative services to Medicare providers, which includes processing claims for medical services, lab tests and outpatient procedures covered under Medicare Part B, the company website explains. Noridian does not determine what items are covered by Medicare, but it may make decisions about whether care is medically necessary, states the Centers for Medicare and Medicaid Services.Continue Reading
Items covered under Medicare part B include services that are needed to diagnose or treat a medical condition, such as visits to the doctor, ambulance services, clinical research and durable medical equipment, including glucose monitors, canes and braces. Medicare part B also covers most preventive services, such as vaccines and screening tests and a limited number of medications, the CMS explains. All Medicare Advantage plans and other Medicare plans must provide enrollees with at least the same coverage that original Medicare provides.
As Medicare administrators, companies such as Noridian Healthcare Solutions determine whether Medicare-covered services are medically necessary and whether the types and costs of the services provided meet established standards of practice, explains Medicare.com. Typically, this is a simple matter of authorizing a service before it is performed. However, in some instances, such as when a person remains in the hospital longer than Medicare's approved length-of-stay, or when a treatment is administered in a higher-cost setting than Medicare typically allows, Noridian may deny a claim. The patient or his family has the right to request a review of these decisions by contacting the Beneficiary and Family Centered Care Quality Improvement Organization in their area, according to the CMS. Additionally, Noridian is not allowed to deny any preventive service covered by Medicare part B, states Medicare.com.Learn more about Health Insurance