Medical Review FAQs - JF Part A
Medical Review Frequently Asked Questions (FAQs)
Q1. Why have I not received Additional Documentation Requests (ADRs)?
A1. When a claim is selected for medical review, the ADR is generated and can be seen in DDE and/or it is mailed as a letter to the provider. Letters are sent to the Correspondence address on file in PECOS (Provider Enrollment, Chain and Ownership System) online enrollment site. For providers with access to Noridian Medical Portal (NMP), ADR letters are available within the message center.
To make changes to where and how your facility receives ADRs, contact the provider contact center at 877-908-8431.
For more information, visit the following websites:
Q2. How do I find medical review results?
A2. Medical Review Results letters are mailed upon completion of the medical review. Medical Review Results letters are also available on Noridian Medicare Portal. Individual claim review determinations that are a part of a medical review can be reviewed within Noridian Medicare Portal by utilizing the claim status inquiry and/or by reviewing the claim within the billing system for remittance advice. Results letters are not sent out for individual claim determination as these are included in the Medical Review Results letter that is mailed at the completion of the file on review.
Q3. What is the status of my Appealed claim?
A3. Medical Review is a separate team from appeals to ensure an independent second level review of the denied claim. Medical Review does not have access to appeal programs to provide status of appeals. Review the claim you have appealed to see if there is an Appeal Decision Correspondence. Redetermination letters are sent after review has been completed. Appealed claim status can be found by reviewing the Appeal Status Inquiry within Noridian Medicare Portal (NMP). Noridian has 60 days from the date of receipt to complete your appeal request. For additional questions or assistance with claims that have been appealed, contact the Provider Contact Center at 877-908-8431.
For more information, visit the following websites:
