Inquiries and Solutions - JE Part B
Inquiries and Solutions
Q. How do I know that my claim is a Recovery Auditor Adjustment?
A. Remark code N432 is used to identify Recovery Auditor Adjustments. This code appears on the claim level header detail line of your Medicare Remit.
Q. When will I receive my demand letter?
A. The Recovery Auditor sends claim processing files to the Contractors or datacenters for processing. Once the claims have processed through the Medicare claim processing systems and an account receivable set up. The responsibility for issuing demand letters to providers is the claim processing contractors (Noridian).
Due to HIGLAS limitations contractors are not able to customize provider addresses. Your Recovery Audtior demand letters are sent to your physical provider address listed in the Provider Enrollment, Chain, and Ownership System (PECOS).
To help providers, Recovery Auditor demand letters will be identifiable. Each Recovery Auditor letter contains an "R" indicator alongside the HIGLAS letter number which can be found in the upper right hand corner of the letter heading.
Q. How do I get a copy of my Recovery Auditor demand letter?
A. Noridian issues Recovery Auditor demand letters. Contact our Provider Contact Center to request a copy of your demand letter.
Q. Why is the Recovery Auditor taking money back on my claim?
A. The Recovery Auditor identifies claim billing issues and requests CMS approval to query those findings and recoup the monies. Noridian does not have any of the query criteria that the Recovery Auditor uses to identify overpayments. Any questions in regard to how a query was run and what criteria were used to determine the overpayment need to be directed to the Recovery Auditor.
Q. What should providers do if they receive an "Informational Letter" from the Recovery Auditor ?
A. The Recovery Auditor is required by CMS to inform providers of all claims they intend to pursue as an overpayment or underpayment. The "Informational Letter" is one of the means the RAC is using to inform providers. If a provider receives an "Informational Letter" notifying them that the Recovery Auditor is investigating a potential overpayment, Noridian suggests doing the following:
- Research the claim information and determine if you agree or disagree with the Recovery Auditor finding.
- Gather supporting documentation to defend the payment of the claim.
- Wait to receive a Recovery Auditor demand letter from Noridian.
The demand letter will give all the next steps and afford providers appeal rights