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Additional Documentation Request (ADR) Timeline Calculator

 

 

Additional Documentation Request (ADR) Submissions

Providers are required, per CMS guidelines, to submit documentation to Noridian within 45 days of the Additional Documentation Request (ADR) date. Initial notice of ADRs may be by Direct Data Entry (DDE) or mail depending on how a provider set up their receipt method. ADRs should be monitored on a weekly basis and documentation should be submitted timely. To retrieve or monitor pending ADRs, providers may access the claim information DDE.

Suspended claims with a request for ADRs are held in location S B6000 or S B6001. To search for all claims in a particular status location, enter the national provider identifier (NPI) and the status location (S B6000/S B6001). Choose Claims option 12. Place an "S" in the SEL field in front of the desired claim and press enter. If an ADR is pending, the information will appear beginning on claim page seven. See the DDE User's Manual for Medicare Part A [PDF] for additional information on accessing DDE.

Documentation should be submitted by the date indicated on the ADR. To ensure proper receipt and processing of the medical documentation, there is specific criteria and/or directive for each type of submission that must be followed.

Once documentation is received, Noridian has 30 days to complete the documentation review and make a determination. The determination will be indicated on a Remittance Advice (RA) and reviewer comments may be accessed via DDE or Noridian Provider Portal. Further information can be found under: Access Medically Reviewed Claim Determinations in DDE or check Eligibility/Claim Status via Provider Portal. Providers without access to DDE or the Noridian Portal can contact the Provider Contact Center (PCC) with any questions on how to register and gain access to these online tools.

If the documentation is not received timely, suspended claims deny as provider liability with an RA Code of N102/56900 for all services billed. For the purposes of the provider error rate, claims denied without documentation will count as denied dollars.

In order to assist providers and decrease the number of claims denied due to not receiving documentation, Noridian Medical Review staff may provide a courtesy call to providers with claims pending 30 days or more. The purpose of the call is to assist providers to identify any claims missed during routine review of their ADRs. These are courtesy calls only and will be completed as workload allows; therefore, not every provider that has pending ADRs at 30 days old will always receive a call.

To also assist providers with timely submission, there are three different options for submission of ADRs.

Note: Noridian is not allowed to reimburse providers for costs related to submission, copying or mailing of documentation.

Hardcopy

To ensure Noridian receives and reviews hard copy documentation in an efficient manner, follow these guidelines.

  1. Include copy of ADR as first page of documentation packet. A provider generated letter including beneficiary Health Insurance Claim Number (HICN), dates of service (DOS) and clear identifier that claim is for Medical Review may be substituted for ADR letter
  2. Staple or clip documentation for multiple claims separately with claim identifying data clearly indicated on top sheet for each claim. This allows for several to be sent in one envelope or package
  3. Copies should be full sheets of one-sided paper. Do not include half sheets or double-sided paper. If your facility uses double-sided forms, verify that beneficiary's name is on each sheet of paper submitted

Return all documentation to address and specific Post Office (PO) Box indicated on ADR letter. Address information is also on Mailing Addresses webpage. Include Attention: Medical Review ADR.

FAX

This method is only available for the initiation submission of Part A Medical Review ADRs. MR ADR Reason codes are identified by the following format: 5xxxx. Fax all Part A documentation to 701-277-7858, Attention: Medical Review Part A ADR.

Note: Reason codes 5Z1xx exception. These are for Zone Protection Integrity Contractor (ZPIC) and documentation must be sent directly to them.

To ensure Noridian is able to identify and accept faxed MR ADR as a receipt, the below requirements must be completed. Failure to follow all of these may result in documentation rejection.

Documentation received for Non-Medical ADRs will not be accepted or routed to other departments.

  1. Place ADR letter on top of medical documentation for each claim or a provider generated letter/form which includes facility contact, beneficiary's HICN, facility name and provider number, document control number (DCN) and DOS
  2. Each claim, including all documentation requested must be faxed individually for proper identification of claims.
    • When faxing documentation, wait for first fax to be completely sent prior to sending in second ADR. Failure to allow adequate time between each faxed claim may cause separate claims to be combined and potentially cause delays with claim review and processing
  3. To ensure documentation is received properly, fax full sheets of one-sided paper. Do not include half sheets or double sided paper
  4. If document is too large for your facility's fax machine capacity to send all information in one transmission, submit via hard copy or CD
    • Documents larger than 200 pages can create difficulties with fax line. Noridian encourages providers to send documents larger than 200 pages either hardcopy or via CD.

CD

To ensure Noridian is able to accept ADR receipt on a CD, providers must follow all of the following requirements. Failure to do so may result in delay of claim/documentation processing.

  1. Images must be submitted in PDF or multi-page TIF format. Image of PDF or TIF file should include ADR letter of claim requested and all requested items in ADR. To ensure accurate identification of submitted records, the ADR letter (containing HICN, DCN and DOS for claim submitted) must be first item on image of file. Do not send paper correspondence. When submitting large PDF files, providers are encouraged to submit in a searchable content capability format.
  2. Multiple ADRs may be submitted on one CD; however, include each ADR must be in separate PDF or TIF file. If ADR records cannot be imaged in one file due to size of medical record, provider must indicate image name method below
  3. Begin Image file names with appropriate HIC and DCN values for record separated by commas. HICN and DCN values are indicated on letter requesting records. If HICN is 000000000A and DCN is 12345678901234, an appropriate file name would be:
    • 000000000A, 12345678901234.tif or 000000000A, 12345678901234.pdf
      If medical record documentation is too large to image to one file format, more than one image per ADR is acceptable but must distinguish them to indicate it is same claim documentation
      Example:
    • 000000000A, 12345678901234,1.tif or 000000000A, 12345678901234,1.pdf
      And
    • 000000000A, 12345678901234,2.tif or 000000000A, 12345678901234,2.pdf
  4. Images must be contained in password-protected ZIP file. Include all images in one ZIP file or use multiple ZIP files (for instance, if one image per ZIP is necessary). If using multiple ZIP files, password must be same for all ZIP files on same CD/DVD
  5. All ZIP files must be placed in root location of CD/DVD. Do not include folders on CD/DVD. Include only one or more ZIP files. Names of ZIP files themselves are not important and can thus be named in any way desired.
  6. Passwords must:
    • Contain at least one upper case letter of alphabet
    • Contain at least one lower case letter of alphabet
    • Contain at least one number
    • Contain at least one special character e.g. %,@,#, etc
    • Be at least 8 characters long
    • Not include words or names
  7. Noridian suggests sending CD via a tracked mailing service; however, it may be mailed by any method provider chooses. All CDs must be sent to the following mailing address: Medicare Part A ADR, 900 42nd St S, PO Box [number indicated on your ADR letter for your state], Fargo, ND 58108-XXXX
  8. Email password, mail tracking number (if applicable) and date sent to email address: naspass@noridian.com. Email should be sent same day CD is mailed or next day at latest

Additionally, Noridian recommends providers follow 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, its contents can be recreated 

Last Updated Oct 04, 2016