How Do I Respond to an ADR? - JF Part A
ADR Timeliness Calculator
How Do I Respond to an ADR?
Providers will receive notice of an Additional Documentation Request (ADR) by mail or electronically, such as via Direct Data Entry (DDE) or Electronic Submission of Medical Documentation (esMD), depending on how a facility has set up their receipt method. Providers have 45 days to respond to an ADR. Inability to respond timely will cause the claim to deny with a Remittance Advise (RA) code of M127/56900 for all services billed. Once documentation is received, Noridian has 30 days to complete the review for pre-pay or 60 days to complete the review for post-pay. 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, we may provide a courtesy call, as our workload allows.
Respond to an ADR: Options for Submitting Documentation
Note: USB Flash Drives are not accepted.
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.
- Place ADR letter or ADR coversheet on top of medical documentation for each claim or a provider generated letter/form which includes facility contact, Medicare ID, facility name and provider number, Document Control Number (DCN) and Dates of Service (DOS).
- Separate multiple claim documents with a blank piece of paper, preferably colored, or a clip with claim identifying data clearly indicated on the top sheet for each claim. This allows for several ADR responses to be sent in one envelope or package.
- 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.
This fax line is for Part A Medical Review ADRs only. 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 Unified Program Integrity Contractor (UPIC) 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.
- Place ADR letter on top of medical documentation for each claim or a provider generated letter/form which includes facility contact, Medicare ID, facility name and provider number, Document Control Number (DCN) and Date of Service (DOS)
- 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
- To ensure documentation is received properly, fax 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, 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
Electronically by CD/DVD
For Noridian to accept records on a CD/DVD, providers must follow all requirements below. Failure to do so may result in delay of claim/documentation processing.
- Image(s)s must be submitted in PDF or multi-page TIF format. Image(s) must include request form of claim requested along with supporting documentation
- Include ADR Letter as FIRST item on file image
- To ensure accurate identification of submitted records, it must include Medicare ID, DCN and DOS for claim being submitted
- Do not sent paper correspondence when mailing CD/DVD package
- Multiple requests may be submitted on same CD/DVD; however, include each separate request in a separate PDF or TIF file
- If supporting documentation cannot be imaged in one file due to medical record size, a provider must indicate image name method below
- For HIPPA and confidentiality purposes, indicate image file names as Patient Account Number or Medical Record Number (MRN)
- MRN3470855.pdf/tiff or MRN1171867.pdf/tiff
- Patient Account #00113746001M1.pdf/tiff orSH00565895.pdf/tiff
- If medical record documentation is too large to image in one file format, more than one image per request will be required. Identify them appropriately and indicate it is same claim documentation
- MRN3470855 1.pdf/tiff or MRN1171867 1.pdf/tiff
- Patient Account #00113746001M1.1.pdf/tiff or SH00565895.1.pdf/tiff
Note: If Noridian needs to contact a provider regarding CD password or files on CD File, the file name should be something Noridian can reference without providing Protected Health Information (PHI).
- Images must be contained in a password-protected format
- Noridian will only accept CDs/DVDs that are zipped using Adobe Security, WinZip, 7-Zip or Secure Zip. (Other formats will not be accepted and CD/DVD will be returned to provider) Images may be included in one Zip file or in multiple Zip files (for instance if one image per Zip is necessary). When using multiple Zip files, password must be same for all Zip files on that CD/DVD
- 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 (i.e., %, @, #, etc.),
- be at least 8 characters long,
- not include words or names.
- All Zip files must be placed in root location of CD/DVD
- Do not include folders or applications on CD/DVD; it must contain one or more Zip files only
- Email password, mail tracking number (if applicable) and date sent to email@example.com
- Send email same day CD/DVD is mailed. Do not mail or fax password, as we will not be able to process the CD/DVD in a timely manner and may result in CD/DVD being returned to provider for resubmission
- Do NOT include PHI information in email
- Do NOT send email as a secure message that requires a password to access
- Noridian suggests sending CD/DVD via a tracked mailing service; however, it may be mailed by any method the provider chooses. See the Mailing Addresses page for state specific Certified/Courier mailings address details.
When mailing confidential information by CD, we recommend providers follow these safeguards.
- Label or indicate "restricted and/or confidential" on CD
- Maintain record of shipment so if package is lost, its contents can be recreated
- Do not mail or fax CD/DVD passwords; use email address provided above
- CDs/DVDs are time-sensitive. To ensure timeliness standards are met, follow information outlined above. Not doing so may result in a delay of CD/DVD processing or it being sent back to provider to be resubmitted
- Noridian accepts documentation via the esMD mechanism. For information on this project, see the esMD webpage.
Last Updated Fri, 16 Dec 2022 19:08:17 +0000