View an ADR
To view the details of an ADR, click on the claim number.
Part B will appear as below, and you will access your ADRs depending on the type of claim your filed:
- Service Specific
- Target Probe and Educate
- Post Pay Review Cases
- RSNAT (will on present if you have filed Ambulance claims)
After selecting a claim number, the "Detail Claim Status" page is displayed. Here you will find details specific to the ADR and claim, including:
- Response Received – This is the date we received the response to the ADR from your office.
- Medical Review Begun – This is the date our MR staff began reviewing the ADR and the documentation submitted with your response.
- Medical Review Doc Completed – This is the date our MR staff completed the review of the claim and submitted documentation.
- Date of Educational Call – If an education call is held with the provider, the date of that call will appear here. This includes providers who are reviewed due to the Targeted Probe & Educate (TPE)initiative.
- Review Results Sent – A date will appear in this field if a letter is sent to the provider. If the claim is paid, no letter will be sent.
- Outcome of Review – Based on the documentation received and reviewed, this is the decision our MR staff made on the claim. Decision options include allow, deny, or partially paid.
- Review Results Code – A code will appear in this field if the review was partially paid or denied.
- Review Closure – This is the date our MR staff completed the review, allowing the claim to continue through the system.
- Review Findings and Rationale – When the claim is partially paid or denied, a letter is sent, and a letter icon will appear in this field. A letter will not be sent if the claim is fully paid.
- Redetermination Outcome – Information will appear here if a redetermination is requested on the claim upon completion of the MR review process. Outcomes are favorable, partially favorable, or affirmed.
- Redetermination Case Closed – This is the date the claim was closed after an appeal was completed (if applicable).