Access Medically Reviewed Claim Determinations - JF Part A

Claims reviewed by Medical Review (MR) receive a medical determination which includes rationale for claim payment or denial, references used for review, denial reason and liability determination. This information is entered in the FISS system claim on the "Remarks Page."

Providers may access this educational information by following the Direct Data Entry (DDE) steps below.

1. At the Main Menu Screen enter "01" and press "Enter" to access the Inquiries sub-menu.
2. Enter "12" and press "Enter" to access the claims screen.
3. Enter the Medicare ID and claim dates of service. "Press Enter."
4. To view claim, place cursor in the "SEL" field on the first line of the claim. Enter "S" to select claim and press "Enter."
5. Find remarks on claim page 4.

In addition to DDE, authorized providers may also view MR claim determinations on the Noridian Medicare Portal. If your facility does not use DDE or Endeavor, the Provider Contact Center (PCC) Customer Service Representatives (CSRs) can provide further claim(s) information regarding the medical review determination.