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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

Non-Medical Record Review Notifications and Results - View details about Non-Medical Record reviews used to determine extent of potential problem areas across multiple DME product classifications and to monitor corrective action measures implemented to reduce improper payments

Pre-Claim Review - Access Advance Determination of Medicare Coverage (ADMC), Power Mobility Device (PMD) Prior Authorization Demonstration, and Required Prior Authorization Programs information

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. View details
 

Last Updated Aug 30, 2018

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