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October 22, 2024

SNF ADR Issue

We are aware of an issue that caused Skilled Nursing Facility (SNF) providers to receive Additional Documentation Requests (ADRs) after their SNF 5-claim probe and educate review is complete.

CGS Action: Within approximately 2 weeks, we will identify the associated claims and release them to process for payment without medical review.

Provider Action: Review claims in the Direct Data Entry (DDE) ADR location (S B6001). If the 'USER ACT CODE' on MAP 171D = Q, we released the claim, and you don't need to respond to the ADR.

To access this information in DDE:

  • Select 01 (Inquiries) from the Main Menu.
  • Select 12 (Claim Summary) from the Inquiry Menu.
  • Key your NPI in the NPI field and S B6001 in the S/LOC field.
  • Select a claim and navigate (F8) to claim page 02.
  • Navigate (F11 x 3) to MAP171D.

If you have any questions, please send an email to: J15AMREDUCATION@cgsadmin.com.

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