ADR Timeline Calculator

ADR Associated Costs

SMRC is not allowed to reimburse providers for costs related to submission, copying or mailing of documentation.

How to Respond to an ADR

Providers/Suppliers will receive an Additional Documentation Request (ADR) by mail and will have 45 days to respond to it; however, extensions may be granted to those providers/suppliers that submit a request to SMRC prior to the end of the specified response timeframe. Once documentation is received and a determination is made by Noridian, a review results letter will be mailed.

Respond to an ADR: Options for Submitting Documentation

NOTE: USB Flash Drives are not accepted.


Hardcopy

To ensure Noridian receives and reviews hard copy documentation in an efficient manner, please follow these guidelines. Failure to do so may result in delay in claim/documentation processing.

  • Place SMRC Response Cover Sheet form on top of medical documentation for each claim
  • Include one-sided full sheet copies. Do not use half sheets or double-sided paper
    • If facility uses double-sided forms, verify beneficiary’s name is on each sheet of paper

Return all documentation to the address and specific Post Office (PO) Box indicated on the ADR letter. Include Attention: SMRC Medical Review.


Fax

To ensure Noridian can identify and accept faxed MR ADR as a receipt, please follow these guidelines. Failure to do so may result in documentation rejection.

  • Place SMRC Response Cover Sheet form on top of medical documentation for each claim
  • For proper identification of claims, provider/supplier must fax each claim, including all documentation requested, individually
    • Wait for first fax to be completely sent prior to sending subsequent information. Failure to allow adequate time between each fax may cause separate claims to be combined and cause review and processing delays
  • Include documentation in full sheets of one-sided paper rather than half sheets or double-sided paper
  • If document is too large for fax machine capacity to send all information in one transmission, refer to postal mail or CD mailing process
  • Documents larger than 200 pages can create faxing difficulties. Noridian encourages providers/suppliers to send documents larger than 200 pages via hardcopy or CD


Electronically by CD/DVD

For Noridian to accept records on a CD/DVD, please follow these guidelines. Failure to do so may result in delay of claim/documentation processing.

  • Images must be submitted in PDF or multi-page TIF format and include ADR with all requested items. Include ADR as first image in file indicating Medicare ID, Document Control Number (DCN) for Part A, Internal Claim Number (ICN) for Part B, Claim Control Number (CCN) for DME and DOS for submitted claim
  • Multiple ADRs may be submitted on same CD; however, each separate ADR should be in a separate PDF or TIF file. If ADR records cannot be imaged in one file due to medical record size, indicate image name method below
  • File Name should be something Noridian can reference without providing Protected Health Information (PHI)
    • This will help if Noridian needs to contact a provider/supplier regarding CD password or files on CD File
  • Images must be contained in a password-protected ZIP file. Include all images in one ZIP file or use multiple ZIP files (for instance, if one image per ZIP is necessary). If using multiple ZIP files, password must be same for all ZIP files on same CD
  • All ZIP files must be placed in CD root location. Do not include folders on CD; CD should only contain one or more ZIP files. Names of ZIP files themselves are not important and can thus be named in any way desired
  • Passwords must:
    • contain at least one upper case letter of alphabet
    • contain at least one lower case letter of alphabet
    • contain at least one number
    • contain at least one special character e.g. %, @, #, etc.
    • be at least 8 characters long
    • not include words or names
  • CD may be mailed by any method provider chooses; however, Noridian suggests sending via a tracked mailing service
  • Email password, mail tracking number (if applicable) and date sent to nhspass@noridian.com. Emails should be sent same day CD is mailed or by next day at latest
  • Additionally, Noridian recommends below safeguards for mailing confidential information by CD
    • Label or indicate CD as “restricted and/or confidential”
    • Maintain a record of shipment so if package is lost, contents can be recreated


esMD

CMS eHealth initiative aligns health information technology (Health IT) and electronic standards programs. The eHealth programs will help improve the health care system including reducing provider paperwork through administrative simplification.

The primary intent of esMD is to reduce provider costs and cycle time by minimizing and eventually eliminating paper processing and mailing of medical documentation to review contractors. A secondary goal of esMD is to reduce costs and time at review contractors. In order to send medical documentation electronically to review contractors, providers/suppliers must obtain access to a CONNECT-compatible gateway.

  • Certain larger providers, such as hospital chains, may choose to build their own gateway
  • Many providers may choose to obtain gateway services by entering into a contract or other arrangement with a Health Information Handler (HIH) that offers esMD gateway services

In the future, CMS plans to go live with providers/suppliers receiving electronic documentation requests when their claims are selected for review. View CMS esMD external-link webpage for details. Access additional CMS resources below.

Last Updated Nov 16, 2018