Medical Review - JA DME
The Medical Review (MR) mission is to reduce supplier 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.
Claim Review Preparation - When a claim requires additional information, Noridian sends a supplier an Additional Documentation Request (ADR) letter requesting supporting claim information. Access documentation preparation, ADR response, and MR decision details
Medical Record Review Results - View details about Service Specific Post-Payment Reviews and/or Pre-Payment Reviews used to determine extent of potential problem areas across multiple suppliers and monitor corrective action measures implemented to reduce improper payments
Pre-Claim Review - Access Advance Determination of Medicare Coverage (ADMC) and Required Prior Authorization Programs information
Serial Claims Review Initiative - View details on the serial claims review initiative
Targeted Probe and Educate (TPE) - View information on TPE review process
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.
CPT, ADA, and AHA End User License Agreement for Providers
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