Frequently Asked Questions (FAQs)

The below FAQs are based on inquiries received from the provider/supplier community.

Why is Noridian asking for documentation?       

The SMRC evaluates Medicare Part A, B and DME medical records nationwide to determine whether Medicare claims were billed in compliance with coverage, coding, payment, and billing practices. The focus of the medical reviews may include vulnerabilities identified by CMS internal data analysis, the Comprehensive Error Rate Testing (CERT) program, professional organizations, and Federal oversight agencies. The SMRC may also carry out other special projects to protect the Medicare Trust Funds as directed by CMS. View the Documentation Requests webpage for related details.

Why was my claim selected for review with the SMRC?

SMRC projects are directed by CMS. Based on the parameters of the project, data analysis is done and a random sample of claims are pulled for review. To determine the reason for claim selection, view the received Post-Payment Claim Review letter. See the indication for review under “Reason for Selection.”

How long do we have to submit a response to the Additional Documentation Request (ADR) letter?

Documentation is due between 30-45 days from the date on the letter. To determine when the documentation must be submitted to the SMRC for review, view the received Post-Payment Notification letter under “When.” View the How to Respond to an ADR webpage for response options and details.

What is the best way to send Medical Records?

Noridian has several ways to accept medical documentation. Documents can be faxed, sent via esMD, secure CD and by courier mail. Important reminders:

  • Include coversheet on top of all medical records pertaining to each individual patient
  • Only send complete medical record packages. Request an extension, if needed, so all documents per patient can be submitted at one time
  • Ensure documents are legible and all required signatures are included
  • Only submit documents one time. Look for confirmation responses when sending by fax and esMD and send any mailed CDs or documents with a tracking number to ensure they are received. This information is helpful if you need to contact us

For more information, see the How to Respond to an ADR webpage under Documentation Requests section.

Last Updated Dec 14, 2018