Services

Health solutions for today’s challenges

Services Overview

Our services focus on

  • Robust administrative services, including claims processing, electronic data interchange, provider enrollment, and call centers
  • Innovative services and solutions to support the battle against fraud, waste, and abuse
  • Analysis and utilization of health care data to inform and drive smart business decision-making

Noridian has received a highly sought after, internationally recognized medical management certification, otherwise known as ISO 9001:2015. This certification assures clients and customers that Noridian follows International Standardization Operating protocol for optimized results across medical entitlement processing, analysis, health care coding, health care call center, customer satisfaction, and other supporting functions.

Administrative Services

Increasingly complex public programs can quickly make administering health care unwieldy. Our approach to health care operations incorporates tools and tactics that have evolved through 50 years of experience ensuring claims accuracy and payment and timeliness while strengthening partnerships with providers. Noridian provides peace of mind for services such as claims processing, contact center, provider enrollment, medical review, inbound mail receipt and imaging, and document workflow. Noridian also offers electronic data interchange (EDI) outsourcing services for multiple health care payers. Noridian is dependable, trusted, and experienced: We currently support Medicare operations in 28 states, the District of Columbia, and three territories, Medicaid operations in two states, and support multiple commercial plans. We are focused on implementing practical, client-based solutions that are

  • flexible enough to meet health plans’ ever changing needs, and
  • cost effective in efficiently integrating with a health plan’s legacy and vendor applications.

With over 50 years of experience processing health care transactions and more than 100 million claims processed annually, Noridian is a trusted alternative in the health care marketplace and provides tested EDI solutions that work. For more information, go to www.edip-hc.com

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We meet detailed and complex security, privacy, data integrity, and functional processing standards. Our culture is one of transparency, compliance, and adaptability—a bedrock for effective and accurate support of any line of business. Our experience is time-tested and proven.


Program Integrity Efforts

With fraud and wasteful spending taking hundreds of billions of dollars away from intended patients, you’ll appreciate a partner that is on the cutting edge of program integrity solutions. Our approach to program integrity incorporates tools and tactics that have evolved through 50 years of experience monitoring claims accuracy and building partnerships with providers.

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Noridian can actively identify community and environmental assets and leverage these to minimize barriers to achieving both individual and community health. We are able to use carefully selected apps and web-based tools to connect with more beneficiaries, community health educators, in-person and telephone coaching, and more. Whether chronic disease self-management, childhood obesity, family health management, or material and child health, Noridian continues to innovate and educate for a healthier today and an even brighter tomorrow.

As a result, we have the experience and expertise to support:

  • Voluntary pre-service or pre-payment reviews
  • Analysis of potential new claim payment edits
  • Case identification and development
  • Filtered and prioritized providers and cases
  • Request and review of medical records
  • Provider education and outreach activities
  • Claims appeals processing and support
  • Claims recovery
  • Facility audits
  • Referrals to external organizations and entities
  • Robust reporting

Noridian’s capabilities in the area of program integrity are reflected in our indefinite delivery/indefinite quality (IDIQ) Unified Program Integrity Contractor (UPIC) award. With these 10-year awards, CMS has partnered with leading program integrity organizations like Noridian to help stop fraud, waste, and abuse across both Medicare and Medicaid.