Claim Additional Development Requests

NOC and unlisted codes.

Modifiers: AS, 22, 52, 53, 62, 66, 80, 81, 82.

PWK initiated and records are not submitted/received timely.

During claim(s) processing, NGS may require additional information to complete the processing of a claim(s); therefore, providers may be required to submit additional documentation and/or information.

ADR responses are typically due 30 days from receipt. Failure to submit documents on time will result in claim rejection.

These ADRs can be responded to by mail using the mailing address provided and can be responded to via NGSConnex.

NGSConnex Temporary issue: If providers do not see the claim ADR in NGSConnex, use the ‘Respond to ADR not in List’ option in NGSConnex. Providers will not be able to select the claim from the list but can still respond.

Claims ADRs are computer generated letters requesting additional information.

The ADRs are mailed via U.S. Postal Service to the billing address of the billing provider and posted in NGSConnex.

Be aware: claim ADRs will state the ADR is from Claims Medical Review and salutation reads “Claims Processing Department.”