What is an ADR and what information does my Medicare Fiscal Intermediary (FI) need in response to an ADR?
The purpose of the Additional Development Request (ADR) is to obtain additional information from the provider while the claim is still active. This request for information is usually in conjunction with the prepayment review process. The ADR informs providers that they have 30 days to submit documentation to support that services were rendered and medically necessary. A copy of the ADR letter must be attached to the front of the medical record sent in by the provider. If the information is not received within the 30-day period, the claim will be denied as not medically necessary due to insufficient documentation. Providers may have to utilize the appeals process if the claim is denied. The ADR includes the claim date(s) of service, specific documentation required for the date(s) of service, and where to return the documentation. Please note that in addition to submitting the specific documentation for the date(s) of service requested, additional documentation supporting the medical nec
