How to Submit Your ADRs

You will receive notice of an Additional Documentation Request (ADR) either by mail or electronically by Direct Data Entry (DDE) depending on how your facility set up their receipt method. You will have 45 days to respond to the ADR.  If you don't respond timely your claim will be denied with a Remittance Advise (RA) code of M127/56900 for all services billed on the claim. Once documentation is received, we have 30 days to complete the review. We are not allowed to reimburse providers for costs related to submission, copying or submitting the medical records to us.

In order to assist providers and decrease the number of claims denied due to not receiving documentation, our staff may provide a courtesy call to providers with claims pending for 30 days or more. These calls will be completed as our workload allows; therefore, not every provider that has pended ADRs will receive a call.

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

Hardcopy

To ensure Noridian receives and reviews hard copy documentation in an efficient manner, follow these guidelines. Failure to follow all of these may result in delay in claim/documentation processing.

  1. Place ADR letter on top of medical documentation for each claim or a provider generated letter/form which includes facility contact, beneficiary's Health Insurance Claim Number (HICN), facility name and provider number, Document Control Number (DCN) and Dates of Service (DOS).
  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 fax line is only for 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 Health Insurance Claim Number (HICN), facility name and provider number, Document Control Number (DCN) and Date of Service (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 identify and accept the CD as a receipt, the below requirements must be completed. Failure to follow all of these may result in documentation rejection.

  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, 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:
    • 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.
      1. Example: HIC#, DCN.tif
  3. 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 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 the provider chooses.
    • 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.
  8. Email password, mail tracking number (if applicable) and date sent to email address: naspass@noridian.com. The email must be sent no later than one day after the CD is mailed.

Additionally, Noridian recommends providers adhere to 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. 

esMD

Noridian accepts documentation via the Electronic Submission of Medical Documentation (esMD) mechanism. For information on this project see the following webpage esMD.


 

Last Updated Apr 21, 2017