Medical Review

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.


Last Updated Oct 13 , 2022

CPT, ADA, and AHA End User License Agreement for Providers

Note: Should you have landed here as a result of a search engine (or other) link, be advised that these files contain material that is copyrighted by the American Medical Association. You are forbidden to download the files unless you read, agree to, and abide by the provisions of the copyright statement. Read the copyright statement now and you will be linked back to here.

CPT codes, descriptors and other data only are copyright 2018 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply.

Copyright © 2018, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the AHA copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB-04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312-893-6816

Making copies or utilizing the content of the UB-04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB-04 Manual and/or codes and descriptions; and/or making any commercial use of UB-04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association.