NORTH DAKOTA HEALTH CARE REVIEW, INC.
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Review Areas

Review Process 

Admission Criteria

Physician Reviewer

Skilled Nursing Facility Criteria - To access this criteria follow this link to Noridian Medicare Part A Manuals page.  To download the Skilled Nursing Facility Criteria, click on the pdf file of Skilled Nursing Facility (SNF).  This is a large file and will take a few minutes to download.  The Skilled Nursing Facility Level of Care begins on page 12 of this manual.

Follow this link to access the Hospital Outpatient PPS home page which contains Addendum E - HCPCS codes that will only be payable as inpatient procedures. 

MedLearn Matters - Follow this link to access "Clarification of Patient Discharge Status Codes and Hospital Transfer Policies"

MEDICAID

Medicaid Review Resources

NDHCRI provides review of Medicaid utilization, as well as pre-authorization review. Occasionally, NDHCRI will engage in focused reviews at special request.

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