General Information

National Government Services or other CMS contractors may need to request additional information for Medicare claims to assess compliance with Medicare rules. These requests are ADRs. An ADR is a notification/letter requesting specific documentation from the provider regarding the claim(s) being reviewed.

Medicare providers are responsible for ensuring the ADR is directed to the appropriate personnel in their organization, to ensure a timely and complete response is submitted to NGS or the other CMS audit contractors.

NGS claims and medical review departments issue ADRs.

• Claims department issued ADRs are pre-pay reviews.
• Medical review issued ADRs can be both post-pay and pre-pay reviews.

CMS-approved audit contractors include CERT, RAC, SMRC, HHS OIG and UPIC/ZPIC. These contractors will send ADRs/notifications directly to the provider/supplier.

• NGS is not involved in these reviews.
• Providers and suppliers submit requested information to the address provided by the contractor
  • Do not submit documentation requested from another CMS contractor to NGS.

Each ADR letter provides the necessary details for responding to a documentation request, including:

• The contractor requesting the records (NGS or another CMS contractor)
• The claim for which the records are needed
• The reason for the request
• The specific medical records required
• The deadline for submission
• The address for sending the records
• Instructions on how to submit the records

To prevent delays in the review process, ensure all requested documentation are submitted promptly, and only send what is being requested.

Revised 5/27/2025