Documentation Requirements - JE Part A
Additional Documentation Request (ADR)
CMS launched a new spring 2023 website "Provider Compliance Group (PCG) / Division of Medical Review (DMR)", specific to Additional Documentation Requests (ADRs). Read more at Additional Documentation Request.
Include Documentation Identifiers
To help Noridian easily identify, sort, and review submitted documentation, include the below details on a coversheet, in a letter, or via the Medical Documentation Submission Form.
- Name of Noridian department that has requested documentation
- Beneficiary name and his/her Medicare Number
- Claim Date(s) of Service and Claim Document Control Number (DCN)
- Provider Transaction Number (PTAN), National Provider Identifier (NPI), and last five-digits of Tax Identification Number (TIN)
Label Documentation - Highly encouraged voluntary effort to help providers/suppliers validate that all requested records are included and to ensure reviewers can easily identify such medical record elements.
Documentation Requirements
Options for Submitting Documentation - Correspondence may be sent to Noridian via mail, fax, electronically by CD/DVD/USB, Electronic Submission of Medical Documentation (esMD), or the Noridian Medicare Portal (NMP).
Reference Guides
The following list may be used as reference guides, when submitting documentation to Medicare. Each charge on a claim should be supported with the following:
- Documentation and Coding that Demonstrates Medical Necessity
- Documentation proving the service/procedure was performed
Documentation Requirements webpages will not be created for every possible situation or provider type.
Provider Type/Topic Specific Requirements
- Ambulance
- Cardiac Services
- Dental Services
- Diagnostic and Therapeutic Services
- Sleep Medicine - Polysomnography
- Drugs, Injections and Biologicals
- End Stage Renal Disease (ESRD)
- Facet Injection
- Hyperbaric Oxygen (HBO) Therapy Services
- Inpatient Prospective Payment System (PPS) Hospital
- Inpatient Psychiatric Facility (IPF)
- Inpatient Rehabilitation Facility (IRF)
- Laboratory
- Outpatient Therapy
- Preventive Services
- Radiation Therapy
- Radiology
- Skilled Nursing Facility (SNF)
- Spinal Fusion
- Total Hip Arthroplasty
- Total Knee Arthroplasty
Additional General Requirements
Documentation Requirements Disclaimer
The documentation requirements contents/references provided within this section were prepared as educational tools and are not intended to grant rights or impose obligations. Use of these documents are not intended to take the place of either written law or regulations.
The listing of records is not all inclusive. Providers must ensure all necessary records are submitted to support services rendered.
Important that physician intent, physician decision and physician recommendation to provide services derived clearly from the medical record and properly authenticated.
The submission of these records shall not guarantee payment as all applicable coverage requirements must be met.
