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February 24, 2023

How to Submit "Additional Documentation" Requested by Part A Medical Review

Please follow the Submission Protocol below if you are contacted to provide additional documentation for an easily curable error identified during the review process to prevent a claim denial. Please fax the requested records to the number provided during the courtesy call.

When submitting documentation for multiple claims, please fax each beneficiary’s documentation SEPARATELY. Multiple claims CANNOT be sent in the SAME fax transmission, or the records faxed will be attached to only 1 claim. Multiple claims MUST be submitted SEPARATELY to ensure receipt of the documents to the proper location.

***DO NOT SEND USING A REDETERMINATION FORM***

Fax Cover Sheet (Page 1) must be a blank page (no numbers) and can ONLY contain the following statement ***Part A MR Additional Documentation Requested***

Fax (Page 2) ***Provide the DCN, beneficiary name and date of service on this page only. Include the number of pages contained within the fax transmission and a staff contact ***

Fax (Page 3, etc.) ***Provide ONLY the documentation requested***

***This is a courtesy call and CGS may not always call to request this type of documentation***

Providers that have been contacted and given the opportunity to submit documentation for an easily curable error must do so by COB 4pm EST within 2 Business Days of the contact. For the documentation to be reviewed, it is critical that the specific instructions outlined are followed.

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