August 17, 2017
Top Medical Review Denial Reason 56900
Reason code 56900 continues to be one of the top medical review denial codes for home health and hospice providers. This denial occurs when a claim is selected for medical review and the provider is requested to submit medical record documentation. Documentation must be received by CGS within 45 calendar days. If the documentation is not received by day 46, the claim is denied with reason code 56900 (documentation not received or not received timely). To help reduce 56900 claim denials, please share the following information with your appropriate staff.
Checking for MR ADRs: CGS encourages providers to use the Fiscal Intermediary Standard System (FISS) to check for MR ADRs at least once per week. To check for MR ADRs, use Option 12 (Claim Inquiry), key your NPI number and the status/location 'S B6001' and press Enter. Claims selected for MR ADR will appear with reason code 39700.

FISS Pages 07 and 08: Access the FISS Pages 07 and 08 to determine what is being requested and the date it must be received by CGS. Pages 07 and 08 only apply to claims in the status/location 'S B6001'. FISS Page 07 displays the due date, which is the 45th day. Page 08 provides details of the information being requested. The requested documentation must be received by CGS on/before 45 calendar days. Attach a copy of FISS Page 07 as the top page of your documentation to ensure it is matched to the appropriate claim.

Submitting Your Documentation: Documentation may be submitted to CGS either by myCGS (CGS Web Portal), US Mail, Electronic Submission of Medical Documentation (esMD), Fax, or on CD/DVD.
- myCGS is a free web portal that allows you to submit your MR ADR documentation directly to CGS. This submission method will help ensure the documentation is received by CGS timely. Once the documentation is submitted you will receive a secure message confirming receipt. A second message will confirm that it was accepted. For additional information, refer to the myCGS User Manual, Chapter 7: 'Forms' Tab
on the CGS website.
- US Mail – Mail paper documentation or a CD/DVD to the address that displays on FISS Page 07.
- esMD is an option for submitting medical record documentation to CGS. You must obtain access to a CONNECT-compatible gateway. For additional information, refer to the Electronic Submission of Medical Documentation Web Page on the CGS website.
- Fax to 1.615.660.5981
Resources
To learn more about MR ADRs, refer to the Medical Review Additional Development Request (ADR) Process Web page on the CGS website. Additional resources include: