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.
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.
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:
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