Medical Review Overview

Our primary mission is to reduce provider billing errors by identifying patterns of inappropriate billing, reviewing claims, and educating providers on medical review claim determination findings. Our primary goal is to pay claims correctly the first time.

We use multiple data sources to identify patterns of inappropriate billing. This includes both data of provider billed claims and errors identified by other CMS contractors. See Other Review Contractors

Once you are identified for a medical review we will notify you for a provider specific review by individual provider letter.

Our plan and philosophy for education is to educate early and often. The ultimate goal of education is to reduce any claim errors identified during a review. We may complete this education in multiple methods and frequency.

See the CMS Medical Review and Education webpage for more detail on the MR program overview.


Last Updated Oct 13 , 2022