Medical Record Review Results

Targeted Probe and Education (TPE) Reviews - Noridian reviews used to help improve a supplier's claim payment error rate and reduce the volume of appeals through claim review and education

Service Specific Post-Payment Reviews - Noridian has no current active Post-Payment Reviews

Service Specific Pre-Payment Reviews - Noridian has no current active Service Specific Pre-Payment Reviews

Supplier compliance results for all TPE reviews completed from October 1, 2019 – December 31, 2019, included:

  • 10-claim preview - 11% compliance
  • Round 1 - 44% compliance
  • Round 2 - 75% compliance
  • Round 3 - 50% compliance
    • CMS referral - 27%
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Review Criteria Current Error Rate Current Review Results
Ankle Foot/Knee-Ankle-Foot Orthosis (AFO/KAFO) TPE Reviews 27%
Diabetic Supplies TPE Reviews 57%
Enteral Nutrition TPE Reviews 22%
Hospital Bed TPE Reviews 47%
Immunosuppressive Drug TPE Reviews 21%
Knee Orthosis TPE Reviews 35%
Manual Wheelchair TPE Reviews 19%
Oral Anticancer Drugs TPE Reviews 46%
Ostomy TPE Reviews 10%
Oxygen TPE Reviews 25%
Positive Airway Pressure (PAP) TPE Reviews 10%
Respiratory Assist Devices TPE Reviews 10%
Spinal Orthoses: TLSO and LSO TPE Reviews 40%
Surgical Dressing TPE Reviews 66%
Therapeutic Shoe TPE Reviews 48%
Urological Supplies TPE Reviews 31%

 

Last Updated Feb 06, 2020