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Medicare DME billing out of network

annawade13

annawade13

Networker
Messages
65
Location
Mebane, NC
I have a provider who is an optometrist, practicing in Nevada. He is not contracted with his Medicare DMERC contractor, Noridian Jurisdiction E. He has a patient who was prescribed medically necessary contact lenses. The patient was notified before dispense that this provider is out of network so no claim would be filed. He called Medicare to ask how to file a claim himself and was told his provider had to file for denial first. This doesn't sound right. I called Noridian and was told we cannot file for a denial, but I don't know what the patient's next step should be. Does anyone have any experience with filing out of network claims to DMERC providers?

Thanks in advance,
 
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