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 January 1, 2020 – March 31, 2020, included:

  • 10-claim preview - 12% compliance
  • Round 1 - 55% compliance
  • Round 2 - 38% compliance
  • Round 3 - 80% compliance
    • CMS referral - 0%
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Review Criteria Current Error Rate Current Review Results
Ankle Foot/Knee-Ankle-Foot Orthosis (AFO/KAFO) TPE Reviews 25%
Diabetic Supplies TPE Reviews 48%
Hospital Bed TPE Reviews 46%
Immunosuppressive Drug TPE Reviews 15%
Knee Orthosis TPE Reviews 70%
Manual Wheelchair TPE Reviews 13%
Oral Anticancer Drugs TPE Reviews 0%
Ostomy TPE Reviews 9%
Oxygen TPE Reviews 15%
Positive Airway Pressure (PAP) TPE Reviews 16%
Respiratory Assist Devices TPE Reviews 37%
Spinal Orthoses: TLSO and LSO TPE Reviews 22%
Surgical Dressing TPE Reviews 72%
Therapeutic Shoe TPE Reviews 44%
Urological Supplies TPE Reviews 29%

 

Last Updated Mon, 04 May 2020 19:46:12 +0000