Medical Review Frequently Asked Questions (FAQs)

Q1. Noridian has offered our facility an educational E-visit to discuss the result of our probe review. Who should we invite to be on the educational call?
A1. Staff recommended to join the call depends on errors found during the review process. Some suggestions include but are not limited to medical records staff, compliance staff, department managers and clinical staff, coders, and physicians. It would be best to determine that with your reviewer setting up the call.

Q2. Our facility has an E-visit set up with Noridian to discuss our recent probe review findings. Can we request a rebuttal or re-review of the denied claims during this time?
A2. E-visits are for education on errors found during the review process, the TPE program does not include a rebuttal process for denied claims. If your facility doesn’t agree with the determination of claims, you do retain your appeal rights. There are some instances when the denials were for technical curable reasons, such as missing documentation that is found after processing of claim, that Noridian MR may reopen the claim for review of those missing documentation pieces. You must request this process and work with the reviewer while your TPE file is still open.

 

Last Updated Dec 19, 2018