Place ADR letter on top of medical documentation for each claim or a provider generated letter/form which includes facility contact, Medicare ID, facility name and provider number, Document Control Number (DCN) and Date of Service (DOS) Each claim, including all documentation requested must be faxed individually for proper identification of claims.
What is a Medicare ADR request?
Providers and suppliers to electronically submit medical documentation requested by the Centers for Medicare and Medicaid Services (CMS) for improper payment review and requests for prior authorization. Review contractors (RCs) to submit Additional Document Requests (ADRs) to providers electronically.
How can providers submit ADR documentation?
Providers can submit requested ADR documentation electronically through the esMD. This process will allow providers to submit medical documentation over secure electronic means. The process is secure, time efficient and cost effective!
How do I monitor claims selected for an ADR?
Your agency should have an internal process established to monitor claims selected for an ADR, and to ensure the documentation is submitted within the required timeframe. If the requested documentation is not received timely by CGS, the claim will be automatically denied.
Will I be notified if my ADR is approved?
You will not receive any other form of notification for an ADR. Your agency should have an internal process established to monitor claims selected for an ADR, and to ensure the documentation is submitted within the required timeframe. If the requested documentation is not received timely by CGS, the claim will be automatically denied.
What is ADR in Medicare?
In general, an additional documentation request (ADR) is generated when documentation is necessary to adjudicate a Medicare claim.
How do you respond to ADR?
Respond to an ADRHardcopy.Fax.Electronically by CD/DVD.Electronic Submission of Medical Documentation (esMD)
What is ADR submission?
Medical Review Additional Documentation Request (ADR) Process. When a claim is selected for medical review, an ADR is generated requesting medical documentation to be submitted to ensure payment is appropriate.
Who is responsible for putting together the necessary information for an additional documentation request ADR )?
Medicare Administrative Contractors (MACs) request medical documentation from the billing provider when the MAC needs more information to make an initial claim determination. The billing provider is responsible for returning the documentation to the MAC within 45 days of the ADR letter date.
What should the ADR response package include?
If you are missing the ADR letter and cannot provide it as the cover sheet, please clearly indicate "ADR Response" and include the following critical information on your cover sheet: Medicare Number, claim number, and dates of service on the claim.
What is ADR for Hospice?
Hospices most commonly find themselves dealing with prepayment medical reviews through the Additional Document Request or Additional Development Request (ADR) process initiated by their fiscal intermediary. Typically, these ADRs relate to a particular probe or edit conducted by the intermediary.
How do you calculate ADR in medical billing?
Measuring Medical Accounts Receivable: “Days in AR”Compute the average daily charges for the past several months – add up the charges posted for the last six months and divide by the total number of days in those months.Divide the total accounts receivable by the average daily charges.
How do I check my DDE ADR?
How Do I Check DDE for an ADR?Enter your national provider identifier (NPI) and the status location (S B6000/S B6001).Choose Claims option 12.Place an "S" in the SEL field in front of the desired claim and press enter. ... See the DDE User's Manual for Medicare Part A for additional information on accessing.
What is an additional document request?
WHAT IS AN ADR? – When a claim is selected for review or when additional documentation is needed to complete the claim, an ADR letter is generated requesting documentation and/or medical records be submitted.
What does ADR mean in development?
Alternative dispute resolution (ADR), or external dispute resolution (EDR), typically denotes a wide range of dispute resolution processes and techniques that parties can use to settle disputes, with the help of a third party.
What is a common reason for Medicare coverage to be denied?
Medicare's reasons for denial can include: Medicare does not deem the service medically necessary. A person has a Medicare Advantage plan, and they used a healthcare provider outside of the plan network. The Medicare Part D prescription drug plan's formulary does not include the medication.
Can you send ADR in one envelope?
This allows for several ADR response s to be sent in one envelope or package. Copies should be full sheets of one-sided paper. Do not include half sheets or double-sided paper. If your facility uses double-sided forms, verify that beneficiary's name is on each sheet of paper submitted.
Does Noridian accept a CD?
Noridian will only accept CDs/DVDs that are zipped using Adobe Security, WinZip, 7-Zip or Secure Zip. (Other formats will not be accepted and CD/DVD will be returned to provider) Images may be included in one Zip file or in multiple Zip files (for instance if one image per Zip is necessary).
Can you send ADR in one envelope?
This allows for several ADR response s to be sent in one envelope or package. Copies should be full sheets of one-sided paper. Do not include half sheets or double-sided paper. If your facility uses double-sided forms, verify that beneficiary's name is on each sheet of paper submitted.
Does Noridian accept a CD?
Noridian will only accept CDs/DVDs that are zipped using Adobe Security, WinZip, 7-Zip or Secure Zip. (Other formats will not be accepted and CD/DVD will be returned to provider) Images may be included in one Zip file or in multiple Zip files (for instance if one image per Zip is necessary).
How long does it take to change your address for a CMS ADR?
CMS guidelines require providers to submit documentation within 45 days of the ADR date. If you need to change the address we have for you to receive ADRs, please complete a CMS-855 enrollment form. For a step-by-step tutorial on filling out the CMS-855 enrollment form to change an address, please review How to Change a Practice Mailing Address.
Can I submit ADR electronically?
Providers can submit requested ADR documentation electronically through the esMD. This process will allow providers to submit medical documentation over secure electronic means. The process is secure, time efficient and cost effective!
Get Started with esMD
Refer to Introducing esMD to New Providers RCs and HIHs (PDF) for benefits and other details.
Current Release Documents
The esMD technical team distributes the following documents for RCs and Health Information Handlers (HIHs) during the course of the release:
Future Functionalities
esMD is planning to support XDR and X12 278 transaction formats for Hospital Outpatient PA requests and responses during the July/October 2020 releases. All HIHs and RCs should review the information provided in the respective esMD release documents.
