Documentation Requests: How, Who and When to Send

As part of the Medical Review process, Noridian requests medical records for some services prior to completing claim processing. A good rule of thumb is to send records which support the service and diagnosis(es) submitted on the claim as well as the medical necessity for the services.

Letters are sent to the Correspondence address on file in PECOS (Provider Enrollment, Chain and Ownership System) online enrollment site.

Medical records could also be requested from other entities outside of Noridian.

Pre-payment: Review of claims prior to payment being received. Prepayment reviews result in an initial determination.

Post-payment: Review of claims after payment has been determined. Post-payment reviews may result in either no change to the initial determination or a revised determination, indicating an underpayment or overpayment.

Request From Days to Respond
(from date on letter)
Response Delivery Options Additional Information

Noridian Pre-pay medical review claims and Targeted Probe and Educate (TPE)

45

Noridian Medicare Portal

Regular mail: Refer to letter

Fax:

  • Part A: 701-277-7858
  • Part B: 701-277-7852

Electronically: CD, DVD, USB, or esMD

Medical Review

Noridian Post-pay - Medical Review

45

Regular mail: Refer to letter

Fax: 701-277-6977

Electronically: CD, DVD, USB, or esMD

Medical Review

CERT (Comprehensive Error Rate Testing)

NCI Information Systems
C3HUB (cms.gov)

45

  • Non-responder contact at day 35
  • Denies after day 75

Regular mail:

CERT Documentation Center
8701 Park Central Drive,
Suite 400-A
Richmond, VA 23227

Fax: 804-261-8100 (use barcode cover sheet)

Electronically: CD, esMD, encrypted email

Comprehensive Error Rate Testing (CERT)

QIO (Quality Improvement Organization)

Review link for state contractor

Determined by request letter

Refer to letter

Locate Your QIO

RAC (Recovery Audit Contractor)

Cotiviti
Welcome to RAC Info (cotiviti.com)
(limited reimbursement for record copy fee)

30

Cotiviti's Secure Provider Portal

Regular mail:

Cotiviti RAC 4
C/O Cotiviti-8000
10701 S Riverfront Pkwy
Box 12005
South Jordan, UT 84095

Fax:

  • Part A: 702-240-5595
  • Part B: 702-240-5510

esMD

Recovery Audit Contractor (RAC)

SMRC (Supplemental Medical Review Contractor)

Noridian SMRC

45

Regular mail: Refer to letter

Fax: 701-277-6834

Electronically: CD, DVD, USB, or esMD

Supplemental Medical Review Contractor (SMRC)

UPIC (Unified Program Integrity Contractor)

Qlarant

45

Regular mail: Refer to letter

Electronically: CD, esMD, Kite Works

Qlarant

 

CMS Resources

Office of Inspector General (OIG) record requests - Refer to letter for details

 

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