Supplemental Medical Review Contractor
Table of Contents
- Supplemental Medical Review Contractor
- Avoid Claim Denials: Ensure Your Address is Accurate and Up-to-Date
Supplemental Medical Review Contractor
Noridian Healthcare Solutions LLC (Noridian) is the SMRC under contract with CMS to perform and/or provide support for a variety of tasks aimed at lowering the improper payment rates and increasing efficiencies of the medical review functions of the Medicare and Medicaid Programs.
Noridian was selected by CMS to conduct nationwide medical reviews as directed by CMS. Noridian conducts nationwide medical reviews (Part A, Part B and DME), in accordance with all applicable statutes, laws, regulations, national and local coverage determination policies, and coding guidance, to determine whether Medicare claims have been billed in compliance with coverage, coding, payment, and billing practices.
Noridian has a responsibility to notify CMS of any identified improper payments and noncompliance with documentation requests. The Medicare Administrative Contractors may initiate claim adjustments and/or overpayment recoupment actions through the standard overpayment recovery process.
The following resources are available on the Noridian Healthcare Solutions LLC website:
- Current SMRC Projects
- Documentation Request
- Letter Examples
- Medical Review Results
The SMRC Contact Center is available:
- Monday‑Friday
- 8:30 a.m.‑6:00 p.m. ET/7:30 a.m.‑5:00 p.m. CT
- 833-860-4133
Avoid Claim Denials: Ensure Your Address is Accurate and Up-to-Date
Noridian Healthcare Solutions, the current SMRC, will send requests to providers and suppliers for additional documentation on claims selected for medical review. These requests comply with the HIPAA Privacy Rule, which allows for the release of information for treatment, payment, and healthcare operations. Sections of the Social Security Act provide guidance that prohibits Medicare from making Part A or Part B payments until sufficient information and/or documentation has been furnished to determine the amounts due.
The SMRC uses the address available in PECOS to send ADRs for medical records.
To ensure that ADRs are sent to the appropriate address, it is important that providers verify the address that is in the PECOS.
Revised 4/30/2024