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.
Medical Record Reviews
- 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
- Targeted Probe and Educate (TPE) - View information on TPE review process
- Advance Determination of Medicare Coverage (ADMC) - View information about voluntary program that allows suppliers and beneficiaries to request prior approval of "eligible" items before item delivery
- Prior Authorization - View details on Power Mobility Device (PMD) Prior Authorization and Required Programs
- Pre-Claim Hotline - View information on a new service tool provided by Medical Review for Pre-Claim and mobility related inquiries
- 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 May 04, 2018
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