Types of Recovery Auditor Reviews - JE Part A

There are three types of Recovery Auditor reviews:

1. Automated (no medical record needed)
2. Semi-Automated (providers are given the option to submit medical records but records are not required)
3. Complex (medical record required)

Recovery Auditors may perform automated reviews which occur when a Recovery Auditor makes a claim determination at the system level without review of medical records.

Recovery Auditors may perform semi-automated and complex reviews and will send providers an Additional Development Request (ADR) for documentation. Providers have 45 days to respond to ensure proper review of documentation. Documentation must be sent directly to the Recovery Auditor not to Noridian.

The Recovery Auditor will not review a claim that has previously been reviewed by another entity. They analyze the claim data using their proprietary software and identify claims that clearly contain improper payments. If an improper payment is identified, a demand letter will be issued.

Providers can identify claims that have been recouped by the Recovery Auditor by checking the remittance advice for the remark message code N432.