Handling Additional Document Request (ADR)
What is Additional Document Request (ADR)?
When a claim is selected for review or when additional documentation is needed to complete the claim, a letter Additional Document Request (ADR) is generated requesting documentation and/or medical records be submitted. The response must be submitted within a specified time frame to the requesting contractor identified in the letter for review and payment determination.
Any claim submitted to Medicare contractors may be selected for an additional documentation request (ADR). Claims may be selected when elements on the claim match the parameters of a pre-payment edit. Medicare contractors will provide an online tool that will help you to receive specific information based on your individual ADR number along with additional resources to make creating your response easier.
Response to Additional Document Request (ADR)
When responding to the ADR letter, it is important that you fully understand what has been requested and when it must be returned to the contractor. You must also package and submit the information correctly. Proper labeling and submission are critical to ensuring your response is processed promptly and accurately. Pay close attention to the contractor name, date due back, HICN or MBI, and Medicare Claim Number.
The response must be submitted within a specified time frame to the requesting contractor identified in the letter for review and payment determination. Each letter specifies how long you have to respond. If you do not reply within that time, you may receive a partial or complete denial of your claim.
Do’s for ADR
- Always place the ADR page(s) that include the square bar code (QR code), the beneficiary’s name, HICN, and Medicare Claim Number. Medicare contractors will use the QR code to control your response. A cover sheet is NOT needed if you are faxing your response.
- Review the claim information. This tells you which claim has been selected for review. Also, review the specific claim line information which shows what you billed and how you billed it.
- Review the letter to see exactly what is being requested. There should be a list of documents needed or a question on one of the claim lines. Make sure to include everything that was requested.
- Always return your documentation to the Medicare contractor identified in the ADR. Sending a response to the wrong contractor could result in significant problems in getting your claim processed promptly and accurately.
- Clearly identify the documentation you have returned: For example, if providing physician notes, a page labeled “Physician Notes” is acceptable. If providing a delivery ticket, a page labeled “Delivery Ticket” is acceptable.
- Be sure to provide all the requested documents. If your ADR letter requests six (6) documents, please be sure your response contains all six requested documents.
- 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: HICN or MBI, claim number, and dates of service on the claim.
- Make sure your documentation is clear and legible.
- Make sure to only send one response with your documentation. That response will be used to make the claim decision.
- Always send separate responses for each claim and never combine them.
Don’ts for ADR
- Never use your own cover sheet instead of the ADR letter. Forms you create to use as a cover sheet are not recognized by their system and may result in delays in routing your response appropriately. Using the ADR letter like the cover sheet will facilitate appropriate routing of your response.
- Never omit the requested information. All information requested must be returned otherwise the response may be incomplete and result in a denial.
- Never combine multiple requests (multiple claims or multiple beneficiaries) into a single response. Combining documents for multiple requests delays your review and may result in a denial. Documentation that includes multiple beneficiaries will need to be split and may be difficult for the contractor to detect. This could result in claim denials if the contractor is unaware that multiple responses are in the same document.
- Never send original documents. Always send a clear copy of the requested information. Medicare contractors do not return your documents.
- Don’t send your response to the attention of a person or department, as you might not have the most up-to-date information and delays could occur. Contractors are able to direct your response appropriately based on the information on the ADR letter.
- Never miss your deadline. Claims will be automatically denied if a timely response is not received. Medicare contractors may decide to reopen your claim but are not required to. If a reopening is done, you will receive a notification on your remittance notice with a new decision.
E2E Medical Billing Services has successfully addressed additional document request (ADR) requests for multiple Medicare contractors. In case of any assistance, you can directly call us at 888-552-1290 or drop an email at info@e2eMedicalBilling.com