ATLANTA--A major HME provider in the Pacific Northwest says it is shy millions of dollars because its Medicare Administrative Contractor, Noridian Administrative Services, has not processed those claims in two months.

"We have just over $3 million in claims sitting with them," said Angelene Adler, vice president of operations for Care Medical Equipment. Based in Portland, Ore., the provider has 11 branches in Oregon and Washington.

Sarah Hanna, vice president of ECS Billing & Consulting in Tiffin, Ohio, also reported difficulties in getting claims paid in the 17-state Region D. "There's a higher denial rate in Region D related to the 176 code--basically an issue regarding [certificates of medical necessity]," she said.

Noridian officials have told ECS that the denials are occurring because its server was moved to a different location, causing a breakdown in communication between the server and its common working files. That has resulted in the CMNs not being attached to the claims, so the claims are being denied.

Noridian also told ECS that it is three to four weeks behind in processing claims but that it will pay providers interest, said Elizabeth Longbrake, accounts receivable supervisor for ECS.

"They are not making the 14-day turnaround," Hanna said.

Adler said her company, which generates revenues of about $35 million a year, first noticed a problem in November. Since then, the payments have been dribbling in. So far this month, Care Medical branches have received checks ranging from 14 cents to $34,000.

Adler said the company's payments for claims have dropped 67 percent, and it is unable to process third-party payer claims. "We can't even bill these as denials because there's no movement at all," she said. "It's going beyond Medicare. It's affecting our Medicaid and HMO [claims]."

Care Medical's attempts to talk to Noridian officials regarding the claims have been fruitless, Adler said. Company staff members have been told Noridian will only accept written complaints, but their e-mails have either not been satisfactorily answered or not responded to at all, Adler said. "They tell us to wait 30 days, but we can't afford 30 days."

In last year's switch from Durable Medical Equipment Regional Carriers to DME MACs, CMS awarded Noridian the bid for Region D over Cigna, which had been the area's DMERC.

Adler said she is concerned that Noridian cannot handle the work. She said staff members have received calls from Noridian employees asking what a capped rental is and what a K0011 is.

"What we would like to see is Cigna reclaiming the contract," she said.

When HomeCare Monday contacted Noridian's corporate office in Fargo, N.D., about the payment issues, a representative who answered the phone said she did not have time to comment.

According to Ann Howard, director of federal policy for the American Association for Homecare, the association had previously been talking with CMS about a different problem with Noridian experienced by a California provider. Related to that issue, she said AAHomecare wants to determine whether Noridian's participation in a three-state test as a Recovery Audit Contractor--rewarded for rooting out erroneous claims on review--conflicts with its job as a claims processor.

AAHomecare will follow up with CMS on Care Medical's situation, said Howard, noting that the association has heard from other sources that additional providers are having problems. Meanwhile, Howard says AAHomecare is trying to learn through state associations and individual companies how far-reaching the payment problems may be and if any have been resolved.

"This is serious stuff," she said. "We need to hear from other providers if they are having this same problem. If it is a systemic problem, then we will have to get a fix on the program rather than just trying to work on each case as it comes along, and, if need be, get Congress involved ... We're totally prepared to do that if we have to."