Ohio Part B Carrier
Medical Review: Additional Documentation Requests (ADRs)
If you receive a Medical Review Additional Documentation Request (ADR) for one or more claims that you have submitted to Medicare for payment, it is important that you comply with the following instructions.
Provide the documents listed on the ADR and any related physician’s orders. Make sure the physician’s signature is legible or include an attestation of signature.
Include a copy of the ADR with your documents
When mailing multiple claim ADR responses, be sure to pair each ADR letter with the corresponding documentation. Pairing these documents ensures the documentation for each request letter is correct for each date of service requested.
Return your documents to the Palmetto GBA medical review mailing address found in the body of the ADR letter
Return your ADR response to Palmetto GBA within 30 days of the date on the ADR letter. The claim will automatically deny by the 45th day if a response has not been received. There is no guarantee that any responses received between day 30 and 45 will be processed prior to the claim being denied.
Once ADR responses are received, CMS requires Palmetto GBA to complete medical review of the documentation within 60 days. Do not resubmit ADR responses to Palmetto GBA.
Do not submit replacement/duplicate claims for the ones pending in medical review. The submission of replacement/duplicate claims will result in claim denial, rejection or recoupment and will prolong the medical review process. When the claim is finalized, the claim will have paid in full or part, or denied. If you disagree with the decision, you can request a redetermination within 120 days of the determination (date on the Remittance Advice).
Several submission checklists have been developed by Palmetto GBA and you may find them useful in verifying what is required for claims submission.
- Chiropractors: Submitting Requested Documentation
- CERT Ambulance Checklist
- Evaluation & Management Services: Submitting Requested Documentation
- Responding to a Request for Therapy Records
last updated on 08/03/2010