29381892 Noridian Commercial Market Rate Card · methods and sources for extracting data Integrates data from multiple and varied sources and applies business rules for creating analytic

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NORIDIAN COMMERCIAL MARKET RATE CARD

Commercial Market Rate Card

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Noridian Healthcare Solutions, LLC (Noridian) has more than 50 years providing professional administrative services in the health care market space, primarily in the public sector. For example, Noridian is the Medicare Administrative Contractor (MAC) to the Centers for Medicare & Medicaid Services (CMS) for Medicare Parts A/B in 13 states and three U.S. territories, serving more than 10.7 million beneficiaries. Noridian is also the Durable Medical Equipment MAC for two jurisdictions, serving more than 24.5 million beneficiaries throughout 28 states, the District of Columbia, and three territories. In addition, Noridian also serves as the Supplemental Medical Review Contractor (SMRC) for CMS – which is the nation’s single largest medical review contract. We process more than 264 million Medicare claims annually, paying out more than $61.5 billion. Noridian also provides a variety of professional services to state Medicaid programs, including integrated consulting services, integrated business program support services, outsourcing recurring commercial activities for financial management services, and program management services.

Noridian has leveraged this extensive experience and knowledge of the health care market space to develop the following standard set of labor categories and rates for the delivery of a broad range of professional services to health care customers in the commercial market. The table below describes the hourly rates associated with each function. These services are available on an hourly (time-and-material) basis at the rates below, or on a fixed price basis using these rates and the agreed upon level of effort. Rates are shown in USD$ for work performed at a Noridian facility and are subject to periodic changes. The exact scope of services, total price and other terms are to be set forth in an agreed upon Statement of Work (SOW) or other agreement, based on the specific needs and goals of our customer. Rates are effective until 12/31/2020. Standard annual escalation is 3%.

For more information, refer to our “Contact Us” page.

Position Noridian Site Rate

Customer Service Advocate I

Duties may include responding to calls or written correspondence and serving as a direct point of contact for customers (including insureds, providers, and suppliers), assisting with information in response to various inquiries. Provides prompt and accurate responses. Documents all inquiries appropriately. Investigates and tactfully resolves escalated customer calls in a professional manner. Individuals working in this labor category may have experience in Medicare, clinical health care, claims processing, or other clinical administrative support.

$46.13


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Customer Service Advocate II

Duties may include responding to complex calls or written correspondence and serves as a direct point of contact for customers (including insureds, providers, and suppliers), assisting with information in response to various inquiries. Provides prompt and accurate responses. Documents all inquiries appropriately. Investigates and tactfully resolves escalated customer calls in a professional manner. Individuals working in this labor category may have experience in Medicare, clinical health care, claims processing, or other clinical administrative support.

$50.68

Claims Reviewer I

Duties may include preparing medical review workloads by key wording, sorting, or processing correspondence and claims in an accurate and timely manner. Performs claims adjudication, research, inquiry notification, and other support duties. Responsible for the accurate, efficient review and processing of claims, adjustment, and/or correspondence. This position follows regulations and standards set forth by the Centers for Medicare & Medicaid Services (CMS) or other agency. Individuals working in this labor category may have experience in Medicare, clinical health care, claims processing, or other clinical administrative support.

$59.56

Claims Reviewer II

Duties may include review of medical documentation, making clinical determinations, policy review or other assessments for payment of claims or responding to prior authorization requests submitted to Medicare or another agency (e.g., for Durable Medical Equipment, Professional, and/or Institutional claims), or providing applicable education. This position applies clinical knowledge to assess and ensure services/items billed are reasonable and necessary, supported by national and local coverage policies, are under accepted billing and coding practices, and meet standards of medical care. Conducts case management, which may include recovery of improper payments due to Fraud/Waste and Abuse. Individuals working in this labor category may have experience in Medicare, clinical health care, claims processing, or other clinical administrative support.

$77.95


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Claims Reviewer III

Duties may include review of medical documentation, making clinical determinations, policy review or other assessments for payment of claims or responding to prior authorization requests submitted to Medicare or another agency (e.g., for Durable Medical Equipment, Professional, and/or Institutional claims), or providing applicable education. This position applies clinical knowledge to assess and ensure services/items billed are reasonable and necessary, supported by national and local coverage policies, are under accepted billing and coding practices, and meet standards of medical care. Conducts case management, which may include recovery of improper payments due to Fraud/Waste and Abuse. Makes independent payment determinations based on Medicare regulations. Provides recommendations for action based on reviews and prepares project reports. Individuals working in this labor category may have experience in Medicare, clinical health care, medical claims processing, or other clinical administrative support.

$80.42

Claims Reviewer IV

Duties may include review of medical documentation, making clinical determinations, policy review or other assessments for payment of claims or responding to prior authorization requests submitted to Medicare or another agency (e.g., for Durable Medical Equipment, Professional, and/or Institutional claims), or providing applicable education. This position applies clinical knowledge to assess and ensure services/items billed are reasonable and necessary, supported by national and local coverage policies, are under accepted billing and coding practices, and meet standards of medical care. Conducts case management, which may include recovery of improper payments due to Fraud/Waste and Abuse. Makes independent payment determinations based on Medicare regulations. Provides recommendations for action based on reviews and prepares project reports. Individuals working in this labor category may have experience in Medicare, clinical health care, medical claims processing, or other clinical administrative support.

$83.07

Analyst I

Duties may include researching, evaluating, and determining appropriate methods and sources for extracting data Integrates data from multiple and varied sources and applies business rules for creating analytic data sets. Responsible for gathering, researching, and validating healthcare data from a variety of data sources in fulfillment of requests and projects from external customers. This position conducts healthcare data analysis to provide actionable information such as data reporting, converting customer requests to technical details, and ensuring deliverable requests are fulfilled. Individuals working in this labor category may have experience in Medicare or other healthcare capacity.

$65.17


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Analyst II

Duties may include establishing the sampling methodology and statistical design for claims analysis used to generate analytic results as required by the contract. Use advanced statistical methods to detect trends and/or aberrancies in provider/supplier practices. Responsible for analyzing, creating, enhancing, and contributing to projects via statistical analysis and reporting. This position performs statistical sampling procedures to support potential investigations into fraud, waste, abuse, medical necessity, or overpayments, as indicated in contractual requirements. This position provides unique proactive data analytic designs to detect billing patterns of interest in support of program integrity activities. Provides an overview of the report findings and recommendations for the data use to appropriate stakeholders. Serves as statistical and data expert based on contractual requirements by leading, coordinating, and educating internal and external stakeholders, as necessary. Individuals working in this labor category may have experience in Medicare or other healthcare capacity.

$96.18

Analyst III

Duties may include establishing the sampling methodology and statistical design for claims analysis used to generate analytic results as required by the contract. Uses advanced statistical methods to detect trends and/or aberrancies in provider/supplier practices. Responsible for analyzing, creating, enhancing, and contributing to projects via statistical analysis and reporting. This position performs statistical sampling procedures to support potential investigations into fraud, waste, abuse, medical necessity, or overpayments, as indicated in contractual requirements. This position provides unique proactive data analytic designs to detect billing patterns of interest in support of program integrity activities. Provides an overview of the report findings and recommendations for the data use to appropriate stakeholders. Collects, analyzes, interprets, and summarizes data to prepare drafts, reports, and presentations of statistical and analytical data. Serves as statistical and data expert based on contractual requirements by leading, coordinating, and educating internal and external stakeholders, as necessary. Individuals working in this labor category may have experience in Medicare or healthcare.

$109.70


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Operations Manager

Duties may include Implementing and managing the contract requirements. Including quality expectations, timeliness, and output requirements of the contract. Manage staffing, contract administration support, compliance and legal requirements, and performance monitoring. Develop and monitor budget. Maintain relationship with business partners. Provide guidance, leadership, planning, and reporting. This position participates as the subject-matter expert to support responsiveness to the business partners as needed. Individuals working in this labor category may have experience in Medicare, clinical health care, claims processing, or other clinical administrative support.

$128.27

Medical Director

Duties may include assuring clinical appropriateness and standard of care for all Medicare activities and processes, within the boundaries of federal law, Medicare regulation and Centers for Medicare & Medicaid Services (CMS) National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs). Perform reviews of analyzed medical claims or records. Provide oversight and direction on policies and regulations. Individuals working in this labor category have experience in Medicare and/or Medicaid and clinical healthcare.

$426.58