Understanding and Resolving 56900 Denial Codes

Table of Contents 

• Reason Code 56900 Description
• Avoiding/Correcting This Error
• Additional Information
• Best Practice for Monitoring Claims
• Scenarios and Next Steps

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Reason Code 56900 Error Description

This claim is denied for payment because the provider failed to submit documentation requested by the MAC via an Additional Document Request (ADR) within 45 days of the ADR date.

Medical review requests documentation for various reasons by sending the provider a request for additional documentation, also known as an ADR. Each ADR has a date in the left-hand corner. If we do not receive the requested information within 45 days of that date, the claim will be denied. NGS recommends responding to ADRs within 35‒40 days of letter date. Use the ADR Timeline Calculator to ensure compliance.

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Avoiding/Correcting This Error

In FISS DDE, regularly access claims in status locations SB6001, SB6098, or SB6099 to obtain a listing of claims for which records have not yet been received by the medical review department. 

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Additional Information

This type of denial can be prevented. When providers receive an ADR, the provider should respond according to the date listed in the ADR. Providers should start gathering the documentation being requested immediately. This will ensure that there is adequate time to gather all the supporting documentation that is being requested so that the timeframe for submitting the information can be met. Please note that, depending on what’s being requested, providers may have to go outside of their facilities to get the supporting documentation, and this may require time to be received from that entity.

The NGS self-service portal, NGSConnex, is the preferred method for ADR response submission and allows providers to respond to ADRs electronically with no need to mail or fax a response to complete the ADR process. 

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Best Practice for Monitoring Claims 

Monitor individual claim results using NGSConnex. Don’t wait for a final results letter to address claim denials. While the results letter will not populate until all the claims for that edit round have been reviewed and processed through the Medicare billing system, you can be proactive with addressing individual claim denials. The article How to Proactively Address Denials will help highlight how your facility can monitor claims using NGSConnex. Each individual claim has an initial determination/remittance date. When submitting an appeal for a claim denial, the appeal must be filed within 120 days from that individual claim’s remittance date.  

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Scenarios and Next Steps for 56900 Denials

If you receive the 56900 denial reason code and have documentation to submit, the NGSConnex User Guide provides steps on how to upload documentation for review.

1. Within 45 days from the initial ADR date: If your facility sent in documentation near the end of the 45-day timeframe and received the 56900 denial:
   • This can occur when the system automatically issues the 56900 before the documentation submitted has been manually accepted into the claims system which can take several days. 
   • While you might initially see the 56900 denial, if you submitted on or before the 45-day timeframe the claim will be updated in the billing system to reflect a timely submission. The original DCN will show it was cancelled in the Medicare billing system and a new reopened DCN will be assigned to the claim. 
   • The medical review team will then review the reopened DCN claim with the documentation submitted and make a determination to pay, deny, partially deny, or recode the claim. 

2. Within 46-60 days of the initial ADR date: You received the 56900 denial and were able to send in  documentation 46-60 days from the initial ADR date:
   • If you are outside of the 45-day timeframe the system will deny the claim with the 56900 reason code.
   • You can submit documentation for the claim 46-60 days after the initial ADR date following the normal Respond to ADR process. While the original DCN will show cancellation in the Medicare billing system, a new reopened DCN will be assigned to the claim. 
   • The medical review team will then review the reopened DCN claim with the documentation submitted and make a determination on the claim.
   • When viewing the medical reviewer findings in NGSConnex or DDE, you may see a notation of “Late Doc”.

3. Outside of the 60 days from the initial ADR date (within 120 days of remittance): You received a 56900 denial and want to send in documentation but you are outside of the 60-day window from the original ADR date:
   • If you are outside of the 60-day window from the original ADR date then the 56900 denial reason code will remain the denial reason code for the claim and be reflected on the Results Letter. 
   • After receiving the initial determination for the claim, you have 120 days from that claims remittance date where you can submit documentation for the claim. You can submit documentation for the claim following the normal Respond to ADR process. (If you do not see the claim listed you will need to follow the Respond to ADR Not in List process to submit documentation.) 
   • A new reopened DCN will be created for the claim. 
   • The medical review team will then review the reopened DCN claim with the documentation submitted and make a determination on the claim.
   • This reopened DCN will not change the payment error rate or claim error rate for the edit round. You can locate and monitor the reopened DCN in the Medicare billing system to see the medical reviewer’s determination. 

The case management team (CMT) provides education to providers following medical review edits. You may contact the CMT via email for any educational related questions. 

• JKACaseManagement@ElevanceHealth.com 
• J6ACaseManagement@ElevanceHealth.com 
• KXCaseManagement@ElevanceHealth.com 

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Posted 8/14/2025