How to Respond to ADR

When a Medicare claim requires additional information, the contractor will send an Additional Documentation Request (ADR) letter requesting the provider to send information that supports the claim(s) being billed. Providers receive notice of an ADR by mail or electronically depending on the providers preference.

Responses should be returned promptly to avoid processing delays and must be submitted within the timeframe documented in the letter to avoid claim denials. Providers have 45 days to respond to ADR.

Respond to an ADR: Options for Submitting Documentation

Noridian Medicare Portal (NMP)

Providers can use the portal to:

  • View a listing of claims pending an ADR response,
  • View a copy of the ADR letter,
  • Respond to the ADR by browsing their computer files and uploading the necessary documentation in various file formats, and
  • View the recent receipt of ADRs submitted through any submission method for pending ADR claims.

Using the portal saves time and costs associated with print or fax submission of the ADR response.

For more information, visit, Noridian Medicare Portal (NMP).

Postal Hardcopy Submission

For proper submission, follow these guidelines:

  • Place ADR letter of ADR coversheet on top of medical documentation for each claim or provider generated letter/form which includes facility contact, Medicare ID, facility name and provider number, Document Control Number (DCN), and Dates of Service (DOS).
  • When submitting multiple documents in the same envelope or package, ensure that each request is clearly identifiable to avoid unintentional merging of documents.
  • Do not submit binders of documentation.
  • Documents should be full sheets of standard-sized paper.
  • All documentation should be returned to the address and specific Post Office (PO) Box indicated on the ADR letter.

Fax Submission

Fax all Part A documentation 701-277-7858, Attention: Medical Review Part A ADR.

Requirements for faxing:

  • Place ADR letter on top of documentation for each claim or a provider generated letter/form which includes the facility contact, Medicare ID, facility name, facility provider number, Document Control Number (DCN), and Date of Service (DOS).
  • Ensure documentation is full sheets of one-sided paper. Do not include half sheets or double-sided paper.
  • If document is too large for your facility’s fax machine capacity to send all information in one transmission or document is larger than 200 pages, submit via other method.
  • Each ADR response must be faxed separately. Wait for first fax to be completely sent prior to sending additional ADRs.
  • Failure to do so causes claims to be combined and potentially causes delays with claim review and processing.
  • Documentation received for non-medical ADRs will not be accepted or routed to other departments.

CD Submission

Noridian accepts records on CD, DVD, or USB. See the Electronically by CD/DVD/USB section of the Options for Submitting Documentation page for submission requirements. Failure to follow these requirements will result in the CD, DVD, or USB being returned.

Electronic Submission of Medical Documentation (esMD)

Noridian accepts Appeals, ADR responses, and Prior Authorizations via the esMD mechanism. For information on this project, see the esMD webpage.

  • Ensure each submission contains the DCN for the claim being submitted.

 

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