Medicare Part B
Ask the Contractor Teleconference Question Submission Form
The Ask the Contractor Teleconferences (ACTs) are designed to open communication between the
provider community and Noridian, which allows for timely identification of problems and sharing of
information in an informal and interactive atmosphere. Use this form to submit your question at least
5 days prior to the ACT. Questions submitted with this form will be answered first. Lines will then be
opened for additional questions, as time permits. Do not include any Personal Health Information (PHI)
or claim specific inquiries. Claim specific questions must be submitted to the Provider Contact Center.
Date of ACT: ______________________________________________________________________________________
Facility Name: ____________________________________________________________________________________
Contact Name:____________________________________________________________________________________
Contact Phone: ___________________________________________________________________________________
Topic: ____________________________________________________________________________________________
Question:
Submit By Email
If you have trouble using this form, email a description of the issues you encountered as well as your
ACT question to [email protected]
CPT codes, descriptions and other data are copyright 2011 American Medical Association (or such other date of publication of CPT).
All Rights Reserved. Applicable FARS/DFARS apply. This article applies to all NAS administered states unless otherwise noted in the article.
A CMS Medicare Administrative Contractor
29319957 (03701) 5-15
Noridian Healthcare Solutions, LLC