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 - 28% compliance
  • Round 1 - 34% compliance
  • Round 2 - 37% compliance
  • Round 3 - 37% compliance
    • CMS referral - 34%
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Review Criteria Current Error Rate Current Review Results
Ankle Foot/Knee-Ankle-Foot Orthosis (AFO/KAFO) TPE Reviews 31%
Diabetic Supplies TPE Reviews 46%
Enteral Nutrition TPE Reviews 33%
Immunosuppressive Drug TPE Reviews 17%
Knee Orthosis TPE Reviews 45%
Oral Anticancer Drugs TPE Reviews 20%
Ostomy TPE Reviews 15%
Oxygen TPE Reviews 29%
Positive Airway Pressure (PAP) TPE Reviews 13%
Respiratory Assist Devices (RAD) TPE Reviews 23%
Spinal Orthoses: TLSO and LSO TPE Reviews 26%
Surgical Dressing TPE Reviews 65%
Therapeutic Shoes TPE Reviews 52%
Urological Supplies TPE Reviews 34%

 

Last Updated Feb 07, 2020