Notice of Admission (NOA)

40.1 - Notice of Admission (NOA) (Rev. 12106; Issued: 06-29-23, Effective: 01- 01-24; Implementation:01-02-24) HHAs must send the NOA to the A/B MAC (HHH) by mail, electronic data interchange (EDI), or direct data entry (DDE). EDI submissions require additional data not required by the NOA itself, to satisfy transaction standards. This data is described in a companion guide available on the CMS website. HHAs may voluntarily agree to adopt the companion guide and use it to submit EDI NOAs at any time. The following data elements are required to submit an NOA under HH PPS. Provider Name, Address, and Telephone Number Required - The minimum entry is the agency’s name, city, State, and ZIP Code. The post office box number or street name and number may be included. The State may be abbreviated using standard post office abbreviations. Five or nine-digit ZIP Codes are acceptable. This information is used in connection with the CMS Certification Number to verify provider identity. Type of Bill Required - 032x - Home Health Services under a Plan of Treatment 4th Digit Definition A Admission/Election Notice D Cancellation of Admission/Election Notice Statement Covers Period (From-Through) Required – The HHA reports the date of the first visit provided in the admission as the From date. The Through date on the NOA must always match the From date. Patient Name/Identifier Required - Patient’s last name, first name, and middle initial. Patient Address Required - Patient’s full mailing address, including street number and name, post office box number or RFD, City, State, and ZIP Code. Patient Birth Date Required - Month, day, and year of birth of patient. Left blank if the full correct date is not known. Patient Sex Required - “M” for male or “F” for female must be present. This item is used in conjunction with diagnoses and surgical procedures to identify inconsistencies. Admission/Start of Care Date Required - The Admission date on the NOA must always match the From date. Condition Codes Conditional. - If the NOA is for a patient transferred from another HHA, the HHA enters condition code 47. Note: No line item service information is required by the Medicare program to complete a Notice of Admission via DDE. However, certain line information is required to meet the requirements of the 837I claim format. See the NOA Companion Guide for details on meeting these requirements. Release of Information Certification Indicator Required - A “Y” code indicates the provider has on file a signed statement permitting the provider to release data to other organizations in order to adjudicate the claim. An “R” code indicates the release is limited or restricted. An “N” code indicates no release on file. National Provider Identifier – Billing Provider Required - The HHA enters their provider identifier. Insured’s Name Required - On the same lettered line (A, B, or C) that corresponds to the line on which Medicare payer information is shown, record the patient’s name as shown on the patient’s HI card or other Medicare notice. Insured’s Unique Identifier Required – The HHA enters the beneficiary’s Medicare Beneficiary Identifier (MBI). Confirm the MBI is active via an eligibility inquiry to avoid delays in the timely receipt or processing of the NOA. Principal Diagnosis Code Required to meet the requirements of the 837I claim format. See the NOA Companion Guide Attending Provider Name and Identifiers Required - The HHA enters the name and provider identifier of the attending physician that has established the plan of care with verbal orders.