Medical Review Frequently Asked Questions (FAQs)

Q1. Why have I not received my notification letter for a Targeted Probe and Educate (TPE) review?
A1. Medical Review Part A sends notification letters via USPS when a file is initiated. Before starting a review, staff verify facility addresses and phone numbers using the billing system and/or facility contact forms if applicable. If contact information cannot be confirmed by phone, letters are mailed to the address listed in the billing system. Providers should contact the Provider Contact Center at 877-609-9960 to update address or ADR delivery preferences, as Medical Review cannot make these changes in the billing system.

If someone outside the audit team within your facility receives a letter, they should forward it to the correct contact. Notification letters include clinician contact information and request a call to confirm the audit point of contact. Facilities with multiple audit contacts should communicate this to the clinician. Providers are encouraged to use the Noridian Medicare Portal to access letters at any time.

For more information, visit the following websites:

Q2. Where can I find Noridian Local Coverage Determinations (LCDs)?
A2. Each Medicare Administrative Contractor (MAC) has statutory authority to create Local Coverage Determinations (LCDs) to cover a particular service or item on a MAC-wide basis for their individual jurisdictions. Noridian has been updating all Local Coverage Determinations and Billing and Coding Articles for Medicare Part A and B to consolidate Jurisdiction E and Jurisdiction F into a single document under the Jurisdiction E version. LCDs can be found on the Medicare Coverage Database and the Noridian Medicare Website.

For more information, visit the following website:

Q3. How can I provide my feedback to the Medical Review team for a Targeted Probe and Educate (TPE) review?
A3. Noridian Medical Review wants to hear from you! Providing your feedback is important to the Medical Review team, as we are always looking for ways to improve your TPE experience. The survey can be taken at any time during your TPE review. The link for the survey can be found on the Noridian Medicare Website under Medical Review and Prior Authorization page on the right side of the screen under Customer Experience. Additionally, the survey link and QR codes are provided throughout the TPE process in email communication with your clinical reviewer, one-to-one educational visits, and results letters that are sent at the end of the review. Be sure to include your contact information for appropriate follow-up. If you happen to have questions, please do not hesitate to reach out to the clinician who is managing your file for assistance.

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