How to Find and Respond to Post Payment Review ADR
The National Government Services Part A MR department will generate ADRs for claims selected for post payment review on a service-specific basis. The ADR is a request to submit documentation for review to ensure proper payment is made. The ADR will have the documentation which should be included for a particular date of service.
Responding to Post Payment Review ADR
In order to avoid claim processing delays, it is important providers respond to ADR in a complete and timely manner. Listed below are guidelines and checklists that will provide assistance in submitting claims:
NGS recommends responding to ADRs within 35‒40 days of letter date (CMS allows providers 45 days of the ADR date). See the ADR Timeline Calculator available on our website for help with determining the target date that the requested medical records must be received by NGS.
The NGS self-service
portal, NGSConnex, is the preferred method for ADR response submission and allows both Part A (including home health, hospice and FQHCs) and Part B providers to respond to ADRs electronically with no need to mail or fax a response to complete the ADR process. Further details are available on our website. If you are a current user of NGSConnex, click on the link for the NGSConnex User Guide for step-by-step instructions on how to submit ADR. If you are not a current user, sign up and get started
If
you mail in your ADR, please send each response separately and attach a copy of the corresponding ADR. It is acceptable to send multiple responses in a single mailing; however, each response must be individually bundled with a copy of the corresponding ADR, place on top of corresponding documents, within the mailing to facilitate proper handling and review of the ADR response.
Include
all records necessary to support the services for the dates requested.
Do not include additional correspondence with documentation submissions. Unrelated
correspondence should be mailed separately.
Records must be complete and legible. Be sure to include both sides of double-sided documents.
Steps to View and Print ADRs from FISS/DDE Provider Online System
Access the claims through the Claims Inquiry screen/option.
Type 01 at the FISS/DDE Online System Main Menu and then type 12 on the Inquiry Menu for claims.
At the Claims Inquiry screen, type SB6001 in the S/LOC field and press <Enter> all claims in the SB6001 status and location will be displayed (SB6001 status indicates that an ADR has been generated for a claim).
At the desired claim, type S to the left of the claim under the SEL
field and press <Enter>.
The ADR letter follows claim page 06 of the claim.
Please note: TPE reviews continue to be on hold due to the PHE related to COVID-19. However, the NGS Medical Review Department will be performing service specific post-payment reviews for a random selection of claims billed to Medicare Part A and B.
Providers are encouraged to review the Medical Review Focus Areas to learn about what services are being selected, what documentation will be requested, and more details on these service specific post-payment reviews.
Have you received a CBR from our Medical Review Department? A CBR can be a very useful tool. Learn more how CBRs can help providers improve their billing efficiency.
This presentation includes information on the NCD for ESAs, alerts and warnings, nationally covered indications, nationally noncovered indications, information on auto-denials, information on appeals, documentation reminders and references.
Medical Review
NGS Medical Review Process
Please note: TPE reviews continue to be on hold due to the PHE related to COVID-19. However, the NGS Medical Review Department will be performing service specific post-payment reviews for a random selection of claims billed to Medicare Part A and B.
Providers are encouraged to review the Medical Review Focus Areas to learn about what services are being selected, what documentation will be requested, and more details on these service specific post-payment reviews.
This presentation includes information on the NCD for ESAs, alerts and warnings, nationally covered indications, nationally noncovered indications, information on auto-denials, information on appeals, documentation reminders and references.
Have you received a CBR from our Medical Review Department? A CBR can be a very useful tool. Learn more how CBRS can help providers improve their billing efficiency.
