Medical Review Frequently Asked Questions (FAQs)

Q1: Is Noridian resuming medical review of claims?
A1: Noridian is resuming medical review activities with post-payment service specific reviews on claims prior to March 1, 2020. For information on services being reviewed please go to the Post-Pay Reviews Medical Review page. The Pre-Pay Targeted Probe and Educate (TPE) program and files continue to be suspended per CMS directive.

Q2: We received a notification letter for a post-payment review, will we get an ADR through DDE or mail like we did with pre-payment and Targeted Probe and Educate (TPE) reviews?
A2: The notification letter serves as both a letter of notification that your facility is being reviewed and the ADR letter. The notification letter has the list of claims being requested and is accompanied by a Response Cover Sheet for each individual claim with the documentation required for medical review.

Q3: How do we respond to a post-payment notification/ADR letter?
A3: Please send in all claims requested with the Response Cover Sheet before each individual claim in one batch. For information on sending in documentation please see the How do I Respond to an ADR Medical Review page.

Q4:  When is the deadline for submitting documentation in response to a post-payment ADR? When will we receive review results?  
A4: The provider response time is the same regardless if the request is for pre-pay or post-pay claims; providers have 45 days to send in documentation for medical review. Noridian Medical Review team has 60 days from receipt of last piece of documentation for all requested claims to have them reviewed and a results letter sent to the provider for post-pay claims.

 

Last Updated Fri, 30 Oct 2020 16:08:11 +0000