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Supplemental Medical Review Contractor (SMRC)

Background

The Centers for Medicare & Medicaid Services (CMS) contracted with Noridian Healthcare Solutions LLC, a Supplemental Medical Review Contractor (SMRC) on February 13, 2018 to help lower improper payment rates and increase efficiencies of Medicare and Medicaid medical review.

The SMRC conducts medical review of Medicare Part A and B claims nationwide. The SMRC evaluates medical records 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.

Additional Documentation Requests

Noridian Healthcare Solutions will send requests to providers and suppliers for additional documentation on claims selected for medical review. These requests comply with the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule, which allows release of information for treatment, payment and healthcare operations. Providers/suppliers must provide documentation upon request to support claims for Medicare services per section 1833 of the Social Security Act.

Overpayments

Noridian Healthcare Solutions will notify CMS of any identified improper payments and noncompliance with documentation requests. The Medicare Administrative Contractor (MAC) may initiate claim adjustments and/or overpayment recoupment actions through the standard overpayment recovery process. For questions regarding the overpayment recovery process or appeal rights, providers and suppliers may contact their MAC. For MAC contact information, please see the review contractor directory.

For more details on the SMRC program you can contact Noridian Healthcare Solutions at 1-833-860-4133, or check out Noridian Healthcare Solutions SMRC Website at https://www.noridiansmrc.com/.

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