Pre-claim review requests can be submitted any time prior to submission of the final claim. Inpatient Rehabilitation Facilities (IRFs) may resubmit requests an unlimited number of times prior to submitting the final claim for payment. Each pre-claim review request should include, at minimum, the following data elements:

Beneficiary Information

• Name
• Medicare Number (also known as MBI)
• Date of Birth

Physician/Practitioner Information

• Name
• National Provider Identifier (NPI)
• PTAN
• Address

Inpatient Rehabilitation Facility Information

• Name
• CMS Certification Number
• PTAN (optional)
• Address

Submitter Information

• Contact Name
• Telephone Number

Other Information

• Submission Date
• Indicate if the request is an initial or resubmission review
  • If resubmission, the Unique Tracking Number (UTN) must be included

Submission Methods

Requesters have the following options for submitting pre-claim review requests to Noridian:

• Mail
• Fax
• Electronic Submission of Medical Documentation (esMD)
• Noridian Medicare Portal (CMS-approved electronic portal)