Noridian Healthcare Solutions

Noridian Healthcare Solutions is a private company headquartered in Fargo, North Dakota, contracted by the Centers for Medicare & Medicaid Services (CMS) to administer Medicare fee-for-service claims. It holds the MAC contracts for Jurisdiction E (Part A and Part B, covering Alaska, Arizona, Idaho, Montana, North Dakota, Oregon, South Dakota, Utah, Washington, and Wyoming) and Jurisdiction F (Part B, covering California, Hawaii, Nevada, American Samoa, Guam, and the Northern Mariana Islands), as well as the DME MAC for Jurisdiction D, which spans a large portion of the western United States.

As a MAC, Noridian issues Local Coverage Determinations and associated billing and coding articles that define covered indications, required ICD-10-CM diagnosis codes, and documentation expectations for procedures ranging from knee and shoulder surgery to orthotic devices. These policies carry the force of CMS guidance within Noridian's footprint and are updated on a rolling basis—ICD-10 billing and coding articles, for example, are refreshed each October 1 to align with the new fiscal-year code set. Orthopedic providers in Noridian's jurisdictions must monitor the Medicare Coverage Database and Noridian's own website for policy changes because a coverage article update can instantly render a previously paid claim unclean.

Noridian also participates in CMS's Comprehensive Error Rate Testing (CERT) program and publishes jurisdiction-specific common-error reports that identify the most frequent reasons for improper payments. For orthopedic claims, recurring CERT findings often center on insufficient documentation of medical necessity, missing operative notes, and incorrect ICD-10-CM specificity. Providers can use Noridian's published checklists—including its clinician documentation checklists for knee orthoses and other DME—to self-audit prior to submission.

If your practice bills Medicare in Noridian's Jurisdiction E, F, or DME Jurisdiction D, Noridian's LCDs and billing articles are the operative coverage rules—not national policy alone. A claim denied for a diagnosis code not listed on a Noridian coverage article will not be overturned simply because the ICD-10-CM code exists in the national code set; the covered-diagnosis list in the applicable article governs. Noridian's CERT common-error reports also signal which orthopedic service types face heightened medical-review scrutiny, making them an essential pre-submission audit tool. Ignoring a recently updated billing and coding article—such as the October 1, 2025 ICD-10 updates—can produce a wave of denials for procedures that were cleanly paid the month before.