MR Relationship with POE - JF Part A

While the Medical Review process assures appropriate claims payment through the review of claims, the POE program assures appropriate claims payment through remedial and proactive provider education. The success of this goal is measured by the continual reduction in the national claims payment error rate. Inherent to that success is a comprehensive effort to educate healthcare providers on coverage and coding principles to ensure correctly billed claims. Medical Review staff works closely with the provider education staff to achieve this success of the POE program. Noridian analyzes medical review findings, prioritizes issues, designs educational interventions that best address issues identified by medical review, and administers education to the provider.

Noridian medical review staff assist with POE activities to address the providers' educational needs proactively; as well as remedial needs identified though the medical review process. The following types of education and methods may be completed dependent on the education needs identified:

• Educational phone calls to the provider
• Educational letters to the provider
• Telephone conference calls with multiple staff employed by the provider
• Face-to-face meetings with the provider
• Bulletin articles
• Face to Face workshops
• Internet telecommunication workshops - educational workshops completed via electronic and telephone media.