CorporateBusiness Services

Additional Development Request (ADR) Overview

In general, an additional development request (ADR) is generated to request documentation from a provider to assist with adjudicating a Medicare claim. CGS generates two types of ADRs for which additional documentation is requested.

  • Medical Review ADR (MR ADR)
  • Non-MR ADR

MR ADRs (Reason Code 39700)

An MR ADR is generated by CGS's Medical Review Department to request a provider's medical record documentation for a specific claim. Claims are reviewed to ensure compliance with Medicare's coverage, coding, payment and billing policies. When a claim is selected for an MR ADR, the claim is moved to the Fiscal Intermediary Standard System (FISS) status/location S B6001 with reason code 39700.

Documentation must be received by CGS within 45 calendar days from the date of the request. The claim will be denied if the documentation is not received by day 46.

Refer to the following resources for details that will assist you in checking claims selected for an MR ADR, and submitting the required documentation:

Non-MR ADRs (Reason Code 39701)

A non-MR ADR is generated when additional information is needed for claim adjudication that is unrelated to CGS's medical review activities. Non-MR ADRs are generated in the following situations.

  • Hospice Exception Requests - When a hospice provider submits a 'KX' modifier, and the REMARKS field (FISS Page 04) is blank, or the information in the REMARKS field does not clearly indicate all circumstances and time frames that supports the exception request, CGS will generate a non-MR ADR to request documentation supporting the exception request for the untimely Notice of Election (NOE). When additional documentation is requested, the hospice claim will move to the FISS status/location S B6001 with reason code 39701. The edit code that appears on FISS Page 08 is 78877.
  • Documentation must be received by CGS within 45 calendar days; however, prompt submission will expedite the processing of your claim. If the documentation is not received by day 46, the claim will be processed as submitted, with noncovered days/charges due to the untimely NOE.

    Refer to the Requesting an Exception for an Untimely NOE CGS Web page for assistance in identifying a non-MR ADR for an exception request.
  • Other Medicare Contractors - CGS may generate an ADR on behalf of other Medicare Contractors (e.g., Zone Program Integrity Contractors (ZPICs), Recovery Auditors (RAs), and Supplemental Medical Review Contractors (SMRCs)) performing medical review of a claim. In this situation, the claim is moved to the FISS status/location S B6001 with reason code 39701.

NOTE: It is important that you review the reason code narrative of the ADR (FISS Page 08). You may need to press F6 to view the full narrative. If the addresses on FISS Page 07 and Page 08 differ, send the documentation to the address that appears on FISS Page 08, instead of the CGS Nashville, TN address.

Refer to the following resources to learn more about other Medicare contractors:

Updated: 12.13.16


Two Vantage Way, Nashville, TN 37228 ©2017 CGS Administrators, LLC. All Rights Reserved