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

Can I be reimbursed for medical records?

On occasion, Medicare providers/suppliers are asked to provide medical records to support claim payment. The CMS Program Integrity Manual, Section 3.2.3.6, states that the Supplemental Medical Review Contractor does not reimburse providers/suppliers for the cost associated with copying of medical records from any setting. Therefore, invoices from record retention centers and copying agencies are not eligible for reimbursement.

How can I submit documentation to SMRC for review?

Noridian SMRC accepts documentation in the following ways:

• Fax:
  701-277-6834
• Mail:
  Noridian Healthcare Solutions, LLC
  SMRC
  4510 13th Ave S
  PO Box 6711 (Omit if sending Fed EX)
  Fargo, ND 58103
• Electronic Submission of Medical Documentation (esMD)
• Encrypted CD/USB

Important reminders when sending documentation to SMRC:

• Include coversheet on top of all medical records pertaining to each individual patient
• Transmit each beneficiary package individually
• 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.

When sending documentation via encrypted CD/USB please review the following tips:

• All passwords, including permissions passwords, must be emailed to NHSPass@Noridian.com
• Please include the following information in the Subject Line:
  • Facility Name
  • Contact Name and phone number if different than person sending the email
• Please include the following information in the Body:
  • Tracking Number if available
  • Project Number
  • Claim Number
• Do not use 0 (zero), capital I’s, lowercase L, or 1’s when possible.
• Include the Tracking Number in the email
• Include a contact name and phone number on the CD/USB, not in the corr.
• Only send documents using .TIF or .PDF
  • Do not save using .exe or other non compatible software
• Do not include software required to download to access the media due to security.
  • If included and we are unable to extract, the CD/USB will be returned.
• If possible, combine documents per beneficiary prior to saving to the CD/USB.
• If possible, send separate CD/USB per beneficiary for large documents.

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

How can you recognize an SMRC audit?

To assist with provider/supplier identification of SMRC correspondence, the SMRC is mailing all letters with the verbiage on the envelopes in red “Immediate Response Required” to help identify these audits.

Please notify your mail department of this to ensure SMRC letters are received by the proper department for appropriate and timely handling.

Can I mail documentation requested by the SMRC and MAC together, at the same time, to the same address?

Although Noridian Healthcare Solutions is contracted with CMS to serve as the MAC and the SMRC, each contract is separate and has no affiliation with the other. Providers and suppliers must submit documentation to the SMRC and MAC independently. Documentation submitted to the MAC (that is intended for the SMRC) will not be received by or forwarded to the SMRC. Similarly, documentation submitted to the SMRC (that is intended for the MAC) will not be received by or forwarded to the MAC. Noridian Healthcare Solutions encourages the provider/supplier community to follow the submission instructions listed in the documentation request letters.

What happens after an SMRC Review?

• Review results are sent to the MAC to process the claim adjustments.
• The MAC issues all demand letters.
• Appeals should be filed with the MAC.
  • If you initially received a No Response letter from the SMRC, and you subsequently submitted the documentation as an appeal to the MAC for review within the SMRC review timeframe, the MAC will forward your appeal request to the SMRC for review. Following the SMRC review a new review results letter will be issues by the SMRC.
  • Overturned decisions will be sent back to the MAC for claim correction.
  • You will still have all level of appeal rights.

How can we update our address for SMRC letters?

Per CMS direction, the SMRC issues additional documentation request letters to providers using provider/supplier addresses contained in the National Plan and Provider Enumeration System (NPPES) and/or the Provider Enrollment Chain, and Ownership System (PECOS). Providers/Suppliers are encouraged to keep addresses current. Providers/Suppliers have the ability to review and update address information within the NPPES NPI Registry. Instructions on updating addresses in NPPES is below. Along with updating NPPES, providers/suppliers should reach out to their Medicare Administrative Contractor’s (MAC’s) Provider Enrollment Department to update Provider Enrollment Chain, and Ownership System (PECOS with any changes in address. It is important that all Medicare correspondence and financial information is sent to the appropriate address.

1. Go to NPPES NPI Registry
2. Enter NPI number into “NPI Number” field and select “Search” at bottom of page
3. If NPI is valid, associated provider information will display
   • Page 1 will include current “Primary Practice Address” and information only
4. Select NPI number to go to second page
   • Page 2 will include other NPI related contact information, highlighted in blue and underlined, currently on file with CMS. Be sure information is correct. If not, make necessary updates
     • “Mailing Address” is address used for all correspondence letters
     • “Primary Practice Address” can be used as correspondence address only, when requested through CMS and/or Provider Enrollment of applicable MAC

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 happens if I don’t respond to an ADR letter?

• If no response is received for an ADR the SMRC will deny claim. If unable to submit documentation by specified timeframe in ADR letter, contact SMRC to request an extension
• Claim decision information is sent to MAC to initiate recoupment of dollars incorrectly paid out for service(s) under review
• MAC will issue an Overpayment Demand Letter
• Must refund overpayment amount or it will be collected by the MAC through offset process
• Overpayment Demand Letter will also include appeal rights. To appeal an overpayment determination, follow appeals process outlined in demand letter

Last Updated Oct 20, 2023