MEDICARE CASE REVIEW
NDHCRI is authorized by the Medicare program as the quality improvement organization (QIO) for North Dakota to review medical care and services provided to Medicare beneficiaries. By law, NDHCRI reviews these cases to determine if the services provided meet medically acceptable standards of care, are medically necessary, and are delivered in the most appropriate setting.
NDHCRI uses the Milliman Care Guidelines for all Medicare utilization and quality reviews in North Dakota.
Skilled Nursing Facility Criteria
Access the following manuals for clarification of Medicare coverage as it pertains to Skilled Nursing Care
Medicare Benefit Policy Manual - Coverage of extended care (SNF) services under hospital insurance
Medicare Claims Processing Manual - SNF Inpatient Part A Billing and SNF Consolidated Billing
Case Review Areas
For specific information on the various review areas, please click on the following topics:
Hospital Discharge Appeals and HINNs
Expedited Appeals
Beneficiary Complaint Review
Alternative Dispute Resolution
Inpatient Only Procedures List - 2009
Inpatient Only Procedures List - 2010
If you'd like to speak with a Case Review Coordinator, please call 701-852-4231.
Who is authorized by law to make health care decisions?
The law authorizes certain persons to make your health care decisions if you are either a minor or if your doctor determines that you are unable to make or communicate responsible decisions about your health care. Follow this link to the A Summary of North Dakota Law Regarding Health Care Directives and refer to pages 15 and 16 for details.
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