How to Respond to ADR - JA DME
ADR Timeliness Calculator
How to Respond to ADR
If a supplier finds a specific HCPCS is routinely selected for an Additional Documentation Request (ADR), the supplier may elect to use the Paperwork, or PWK, process.
- Sample ADR Letter [PDF]
Respond to an ADR: Options for Submitting Documentation
- Noridian Medicare Portal (NMP)
- Fax Submission
- Postal Hardcopy Submission
- CD Submission
- Electronic Submission of Medical Documentation (esMD)
Noridian Medicare Portal (NMP)
Suppliers 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.
- Place ADR letter on top of medical documentation for each claim or a provider generated letter/form which includes facility contact, beneficiary's Medicare ID, facility name and provider number, Claim Control Number (CCN) and DOS.
- Each claim, including all documentation requested, must be faxed individually for proper identification of claims.
- When faxing documentation, wait for the first fax to be completely sent prior to sending the second ADR. Failure to allow adequate time between each fax may cause separate claims to be combined together and potentially cause delays with the claim review and processing.
- Documentation should be full sheets of one-sided paper rather than half sheets or double sided paper to ensure information is received properly.
- If document is too large for your fax machine's capacity to send all information in one transmission, refer to postal mail or CD mailing process.
- Documents larger than 200 pages can create difficulties when faxing. Noridian encourages providers to send documents larger than 200 pages via hardcopy or CD.
Postal Hardcopy Submission
All documentation that is submitted hard copy should follow these guidelines for an ADR submission to help Noridian receive and review the documentation in an efficient manner.
- Place a copy of the ADR as the first page on your documentation packet. A supplier-generated letter which includes the beneficiary Medicare ID, dates of service (DOS) and a clear identifier that this claim is in response to an ADR request may be substituted for a copy of the ADR letter.
- If you are responding to multiple ADR requests, clearly separate the documentation for each claim. Staple or clip documentation for multiple claims separately with claim identifying data clearly indicated on the top sheet for each claim. This allows for several to be sent in one envelope or package.
- Copies should be full sheets of one-sided paper rather than half sheets or double-sided paper. If your facility uses double-sided forms, verify the beneficiary's name is on each sheet of paper.
All documentation should be returned to the address and specific Post Office (PO) Box indicated on the ADR letter.
In order to accept ADR receipt on a CD, providers must follow all of the following requirements. Failure to follow all of these instructions may result in delay of claim/documentation processing.
- Images must be submitted in PDF or multi-page TIF format and should include the ADR letter and all requested items. The ADR letter should be the first image in the file indicating the Medicare ID, CCN and DOS for claim being submitted to ensure accurate identification of submitted records. No paper correspondence should be sent when mailing a CD package.
- Multiple ADRs may be submitted on the same CD, however each separate ADR should be in a separate PDF or TIF file. If ADR records cannot be imaged in one file due to the size of the medical record, then you must indicate the image name method below.
- Image file names should begin with appropriate Medicare ID and CCN values for record separated by commas. Medicare ID and CCN values can be found on the letter you received requesting records.
- Images must be contained in a password-protected ZIP file. You can either include all images in one ZIP file or use multiple ZIP files (for instance, if you need to put one image per ZIP). If you use multiple ZIP files, the password must be same for all ZIP files on same CD.
- All ZIP files must be placed in root location of CD. There should be no folders on CD; only thing on CD should be one or more ZIP files. Names of ZIP files themselves are not important and can thus be named in any way desired.
- Passwords must meet the following requirements:
- Passwords must contain at least one upper case letter of alphabet
- Passwords must contain at least one lower case letter of alphabet
- Passwords must contain at least one number
- Passwords must contain at least one special character e.g. %,@,#, etc.
- Passwords must be at least 8 characters long
- Passwords must not include words or names
- CD may be mailed by any method the provider chooses; however, Noridian suggests sending via a tracked mailing service.
- Email the password, mail tracking number (if applicable) and date sent to email@example.com. Emails should be sent the same day the CD is mailed or by the next day at the latest.
- Additionally, Noridian recommends the following safeguards for mailing confidential information by CD:
- CD should be labeled or indicate "restricted and/or confidential" on it.
- A record of shipment should be maintained so if package is lost, the contents can be recreated.