When a provider/supplier receives an Additional Documentation Request (ADR) letter from Noridian, they are required to provide medical records and supporting documentation needed to review the referenced Medicare claims. Such a request complies with the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule, which allows release of information for treatment, payment, and healthcare operations.

ADRs are mailed to the address a provider/supplier has on registry with CMS.

How to Respond to an ADR – Learn about the ADR process and how to submit requested documentation

Medical Documentation Signature Requirements – View signature requirement details

Provider Compliance Group (PCG) Medical Review Process Flowchart – View a flowchart outlining the PCG Medical Review Process

Resources

• Additional Documentation Request (ADR)  
• CMS Internet Only Manual (IOM), Publication 100-08, Medicare Program Integrity Manual  
• CMS Medicare Coverage Database (MCD)  
• CMS MCD Archive  
• 42 USC 1320(c) (5) (A) (3) and 1833 of the Social Security Act

Last Updated Mar 22, 2024