Medical Review (MR)

The Medical Review (MR) mission is to reduce provider billing errors and ensure that Medicare claims are paid correctly while maintaining the Medicare Program integrity. To reduce claim submission (coverage/coding) and payment errors, and increase timely payments, data is gathered and errors are identified and addressed. It is our philosophy to educate early and often; therefore, the MR and Provider Outreach and Education (POE) team creates coverage and guideline related articles, informational materials, and provide education on claims denied through MR and/or other review contractors. View the CMS Medical Review and Education webpage for details.

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.

Documentation Requirements - View reference guides for submitting documentation to Medicare

How to Read an ADR - View information about how to read an ADR Letter

How Do I Respond to an ADR? - Learn about the ADR process and how to submit requested documentation

MR FAQs - View frequently asked MR related inquiries and the answers to them

MR Overview - View the MR primary mission, plan and philosophy

MR Reopening - View information on how to request a Medical Review Reopening

Medical Documentation Signature Requirements - View signature requirement details

Order Authentication Requirements - View requirements as a condition of participation

Prior Authorization - Access Prior Authorization Program information

Post-Pay Reviews - View information related to post-pay claim reviews and notification of service topics

Pre-payment Review - View current and completed Noridian pre-payment service specific reviews

Targeted Probe and Educate (TPE) - View information on the TPE pilot process

Who Reviewed My Claim? - View information to help providers determine which contractor reviewed a claim

Why is My Claim Denied? - How to access narrative detail reasons on reviewed claims

Other Review Contractors - Multiple CMS contractors complete reviews of medical records. This includes Comprehensive Error Rate Testing (CERT) Contractor, Recovery Auditor (RA) Contractor, and many more. View details
 

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