Q1. Why are additional records being requested from the ordering provider when documentation has already been submitted and reviewed?
A1. The documentation submitted by the laboratory may not always contain all of the clinical information that supports why the test was ordered. Additional records from the ordering provider, such as progress notes, prior test results, or other clinical documentation, may help demonstrate medical necessity for the service. Noridian may request that information directly from the ordering provider before making a final determination.

Q2. How can I provide my feedback to the Medical Review Team for a Targeted Probe and Educate (TPE) Review?
A2. Noridian Medical Review wants to hear from you! Providing your feedback is important to the Medical Review team, as we are always looking for ways to improve your TPE experience. The survey can be taken at any time during your TPE review. The link for the survey can be found on the Noridian Medicare Website under Medical Review and Prior Authorization page on the right side of the screen under Customer Experience. Additionally, the survey link and QR codes are provided throughout the TPE process in email communication with your clinical reviewer, one-to-one educational visits, and results letters that are sent at the end of the review. Be sure to include your contact information for appropriate follow-up. If you happen to have questions, please do not hesitate to reach out to the clinician who is managing your file for assistance.

Q3. What recommendation does Medical Review consider most important for providers to follow?
A3. Medical Review's recommendation is to ensure the medical record clearly supports the services billed. Documentation should clearly show why the service was needed, what care and services were provided, and how the service meets Medicare coverage requirements. By having clear and complete documentation this helps support the service billed and demonstrates medical necessity, which may reduce the chance of denials or additional documentation requests.