Provider Guidelines

Credentialing

All providers who join the Nomi network are required to provide documentation to ensure accreditation, education and training, certifications, licensure, professional liability insurance, malpractice history and professional competence. Providers wishing to join the Nomi network may begin by submitting a completed credentialing form using the link below, or by providing CAQH information. Credentialing can take up to sixty to ninety (60-90) days to complete and providers are not considered participating until such time as credentialing is successfully approved.

• Contracted providers are required to maintain their credentialed status with Nomi by completing a re-credentialing application every three (3) years.

Verifying Eligibility & Benefits

To verify eligibility call 877-794-2333

Prior Authorization

Traditional health plans require some procedures and services require an authorization prior to rendering care. At this time, Nomi Health does not require prior authorization on any procedure.

Claims Submission

Providers may submit a clean claim containing complete and accurate information necessary to adjudicate a claim and are consistent with industry standard billing requirements. Claims must include valid National Provider Identifiers (NPI), Tax Identification number, and applicable Medicare/Medicare numbers.

• Paper claims: Nomi does not accept paper claims at this time.
• Claims may be submitted electronically via Change Healthcare using the following Nomi Payer ID: 66066.
• Claims must be submitted within ninety (90) days from the date of service if no other state-mandated or contractual definition applies.

Claim Editing

Electronic claims are subject to claims editing to ensure proper coding of services. Claims editing sources include but are not limited to; the American Medical Association Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS) and International Classification of Diseases (ICD). In addition, Nomi also considers guidelines issues by the Centers for Medicare & Medicaid Services (CMS), correct-coding initiatives, national benchmarks, and industry standards.

Claim Status

Providers may inquire about claims status by emailing providerservices@nomihealth.com.

Electronic Billing and Payment

Providers can choose to have claim payments sent directly to their designated bank account by completing the enrollment steps during the provider settlement process.

Reconsideration & Appeals

Appeals can made to Nomi Health by submitting a written request to providerservices@nomihealth.com.

• Requests for reconsideration and appeal require patient name, date of birth, date of service, medical record number, and supporting documentation to support the appeal.
• Reasons for appeal
• Timeline
• Communication
• Second level appeals