Medicare contractor · Jurisdictions E and F
Noridian Dermatology Billing (Jurisdictions E and F)
Noridian Healthcare Solutions is the Medicare Administrative Contractor for Jurisdiction E (California, Hawaii, Nevada and the Pacific territories) and Jurisdiction F (Alaska, Arizona, Idaho, Montana, North Dakota, Oregon, South Dakota, Utah, Washington and Wyoming). It processes Part B dermatology claims for those states and publishes the local coverage determinations that decide when a lesion removal, destruction or Mohs stage is payable there.
Noridian Healthcare Solutions is one of the contractors covered in our Medicare dermatology billing guide, which explains how local coverage determinations, advance beneficiary notices and global periods reach the claim before any contractor-specific rule applies.
Why Noridian jurisdictions are surgical-heavy
The Noridian footprint includes the sun-belt retirement markets of Arizona and Nevada and the large California book, so a far larger share of revenue sits in excision, destruction and Mohs codes than in office visits. When surgical documentation slips, the revenue effect is immediate rather than gradual.
Stage counting on Mohs, repair classification after the final stage and lesion counts on actinic keratosis destruction are the three areas where Noridian medical review concentrates in dermatology.
What Noridian Healthcare Solutions decides for your dermatology claims
Noridian Healthcare Solutions does not write Medicare's benefit categories, but it writes the local coverage determinations, the billing and coding articles and the medical review edits that decide whether an individual dermatology claim is paid. Coverage language for benign lesion removal, actinic keratosis destruction, Mohs micrographic surgery and photodynamic therapy is contractor-level policy, and the version that matters is the one active on the date of service.
The billing and coding article attached to each policy usually carries the diagnosis code list and the documentation wording a reviewer applies. Practices that read only the policy and never the article are the ones surprised by a denial that cites a code they thought was covered.
How we work these claims
- Policy set is loaded per location so a group crossing a jurisdiction line bills each site under the contractor that actually governs it.
- Pre-bill scrub checks lesion counts, destruction units, excision measurements and Mohs stage sequences against the note before release.
- Liability modifiers are paired with a signed advance beneficiary notice obtained before the service, never reconstructed afterwards.
- Denials are grouped by policy citation rather than by CPT, so the corrective action lands on the documentation template that caused them.
- Redetermination deadlines are tracked per claim, with reconsideration and ALJ escalation where the contractor's reading of its own policy is wrong.
Appeals inside the Medicare levels
Medicare appeals run in fixed levels: redetermination by the contractor, reconsideration by a qualified independent contractor, then an administrative law judge hearing. Each level has its own filing window, and a claim that misses one cannot re-enter at the next.
Most dermatology redeterminations succeed or fail on one thing — whether the operative or progress note states the clinical fact the policy asks for. We attach the note excerpt and the policy language side by side rather than sending a form letter.
States in Jurisdictions E and F
- California
- Hawaii
- Nevada
- Alaska
- Arizona
- Idaho
- Montana
- North Dakota
- Oregon
- South Dakota
- Utah
- Washington
- Wyoming
Markets Noridian Healthcare Solutions governs
These are the metro billing guides inside this jurisdiction. Each one sets out the local payer mix that sits on top of Noridian Healthcare Solutions policy.
Dermatology billing in Phoenix
Phoenix, Scottsdale, Mesa, Tempe, Chandler and Tucson
Dermatology billing in Los Angeles
Los Angeles, Beverly Hills, Santa Monica, Pasadena, Long Beach and Orange County
Dermatology billing in San Diego
San Diego, La Jolla, Carlsbad, Chula Vista and North County
Dermatology billing in Las Vegas
Las Vegas, Henderson, North Las Vegas, Summerlin and Reno
Frequently asked questions
Do we have to follow Noridian Healthcare Solutions policy if our practice is somewhere else?
Jurisdiction follows the location where the service was rendered, not where the practice is headquartered. A group with sites in more than one jurisdiction is subject to both rulebooks.
Our claim was paid last year and the same claim denied this year. What changed?
Local coverage determinations and their billing and coding articles are revised on the contractor's own schedule. Check the policy version effective on the date of service before appealing.
Is a Noridian Healthcare Solutions denial appealable?
Yes, through the standard Medicare appeal levels, provided the redetermination is filed within the window. Denials caused by documentation that never stated the covered indication are better fixed at the template than at appeal.
Other Medicare contractors
Working with Noridian Healthcare Solutions
We bill dermatology only, inside your practice management system, with the Noridian Healthcare Solutions policy set loaded per location. If your Medicare denials keep citing the same policy, send us a remittance sample and we will tell you which documentation line is producing them.