January 04, 2013
Update on Noridian Denials of Claims for Monitored Anesthesia Care (MAC)
ASA recently became aware of a claims processing change involving Monitored Anesthesia Care cases handled through Noridian. Specifically, Noridian had been denying claims for cases performed under Monitored Anesthesia Care (MAC) that are not subject to the Noridian Local Coverage Determination (LCD) on MAC (ID L24332). ASA contacted Bernice Hecker, MD, Noridian Contractor Medical Director, who informed us that there have been inappropriate denials due to issues with a system update. Dr. Hecker stated, "Noridian took urgent action to terminate the edit when providers alerted us to the potential of inappropriate denials. Correction was fully implemented and operational as of yesterday [Jan 2, 2013]. NAS sincerely regrets any and all inappropriate denials and we will make the adjustments to claims. Providers do not need to resubmit." Noridian assures us that identification of and adjustments to claims that were impacted by the problematic edit will be handled on a high priority basis. That process will start next week and should take about 2-3 weeks to complete.
ASA appreciates Noridian’s prompt attention to this matter.