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ADS Requests for Medical Record Submissions

When submitting documentation in response to a Noridian Automated Development System (ADS) letter, follow the guidelines below.

Noridian Medical Review (MR) Part B currently submission of documentation using the post office/courier service, fax, or Electronic Submission of Medical Documentation (esMD).

There are specific criteria for each type of submission that must to be followed to ensure proper receipt and processing of the medical documentation.

Per CMS guidelines, providers are required to submit the documentation to Noridian within 30 days of the ADS letter date. Noridian suspends the claim for a total of 45 days to allow for any mailing delays. If documentation is not received within this timeframe, the claim will automatically deny as Contractual Obligation. We cannot reimburse providers for costs related to submission, copying or mailing of the documentation.


When submitting documentation (via FedEx, certified mail or regular mail) in response to an ADS letter, follow the guidelines below to help Noridian receive and review documentation in an efficient manner.

  1. Include a copy of the ADS letter followed by the applicable documentation for that specific letter only.
    • If including more than one ADS letter within packet, each ADS letter and its documentation must follow same order
    • If same documentation applies to more than one ADS letter, additional copies of documentation must be placed behind applicable ADS letter
    • A provider generated letter which includes beneficiary Health Insurance Claim (HIC) Number, Dates of Service, Internal Control Number (ICN), and a clear identifier that the claim is for medical review may be substituted for ADS letter
  2. Staple or clip documentation for multiple claims separately with claim identifying data clearly indicated on top sheet for each claim
    • 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
    • Do not use highlighters as they can obscure documentation

All documentation should be returned to the address and specific Post Office Box indicated on the ADS letter.


Faxing is only available for original submissions of documentation for Part B Medical Review requests.

In order for Noridian to identify and accept the faxed MR ADS letter and documentation as a receipt, Noridian is requesting providers follow all the requirements below. Failure to follow all of these instructions may result in rejection of the documentation.

Documentation that is received for non-Medical Review ADSs will not be accepted or routed to other departments. This must be faxed to the designated fax number for non-medical review documentation available on our website.

  1. Use a cover sheet. Do not include Protected Health Information (PHI) on cover sheet; however, it can be included in subsequent pages of fax transmission
  2. Place ADS letter on top of medical documentation for that claim. If same documentation applies to more than one ADS letter, additional copies of documentation must be placed behind applicable ADS letter. For proper identification of claims, each claim, including all documentation requested, must be faxed individually
    : When faxing documentation, wait for first fax to be completely sent prior to sending in second ADS. Failure to allow adequate time between each faxed claim may cause separate claims to be combined together and potentially cause delays with claim review and processing
  3. Documentation should be full sheets of one-sided paper.
    • To ensure information is received properly through fax line, do not include half sheets or double sided paper
    • Do not use highlighters as they can obscure the documentation
  4. If document is too large for your fax machine's capacity to send all information in one transmission, refer to hardcopy process

Last Updated Jul 27, 2015

ADS Submission


Electronic Submission via esMD

Fax 701-277-7852

Mail Attn: ADS

Each state has its own PO Box. See Mailing Addresses for these numbers.


Providers: Send requested documentation for all dates of service included in ADS Letter

Last Updated Jul 27, 2015