Methods for Submitting an ADR
Table of Contents
Submitting Documentation
NGSConnex is the preferred method of submission.
National Government Services accepts documentation by NGSConnex, mail, esMD, CD/DVD and fax.
NGS recommends responding to ADRs within 35-40 days of the letter date. CMS allows providers 45 days from the ADR date. Use the ADR Timeline Calculator to help determine the target that that NGS must receive the requested medical records. Do not include additional correspondence with documentation submissions, only submit the documentation for the ADR and the procedure code requested. Unrelated correspondence should be mailed separately. Records must be complete and legible and include all information necessary to support the services for the dates of service requested. All services must include the required signatures and credentials of professionals. See the CMS IOM Publication 100-08, Medicare Program Integrity Manual, Chapter 3, Section 3.3.2.4, “Signature Requirements.”
NGSConnex
- Please visit the NGSConnex User Guide to learn about NGSConnex, and please contact the Provider Contact Center for questions on NGSConnex.
- In NGSConnex, there is an ADR option that you will be able to view the text of the ADR sent, check an ADR decision and verbiage on the denial. Please check the NGSConnex user manual for further instructions on the use of the ADR option.
Mailing an ADR
- Be sure to mail the requested documentation to the correct NGS P.O. Box.
- 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 within the mailing to facilitate proper handling and review of the ADR response.
- No staples.
- Place the appropriate ADR on top of the correct medical records.
- Be sure to include both sides of double-sided documents.
CD/DVD
- Records should be submitted in PDF format via an encrypted electronic media (CD, USB).
- To protect PHI, encryption using Secure-Zip is suggested. Please do not submit the password information with the CD. Provide the password in a separate mailing.
- Each beneficiary should be saved as a separate file.
- Please provide a contact name and phone number in the event an electronic media cannot be opened or read.
- Electronic media that cannot be read or opened will be returned after five days with no response.
esMD
- Information on signing up for esMD can be found on the CMS website: Electronic Submission of Medical Documentation (esMD) Overview
Fax
- A copy of the ADR must accompany the fax.
Revised 6/6/2023