HHA Prepayment Review Letters a/k/a Additional Development Requests

Good Afternoon MFS Bloggers, I have seen an influx of ADR letters recently coming from wither the RHHI or your local ZPIC’s requesting medical records prior to adjudicating your caims for payment. The below information is taken from a recent CMS transmittal. Please follow these CMS instructions very carefully when responding to an ADDR letter as your cash flow depends upon your strict adherence.

Additional Development Requests (ADRs)

An ADR is a request from Palmetto GBA for copies of medical records for review purposes:
– A provider has 30 days to respond and submit documentation for review
– ADRs are mailed in a bright yellow envelope with ‘ADR Request Time Sensitive’ in red on the envelope.
– Submit the requested documentation to the address on the ADR using the appropriate mail code.
– It is suggested that the provider track an ADR from the time it is received/printed until the status/location SB6001
– To print a hardcopy ADR from DDE, select 01 ‘inquiries’. Press enter and select 12 for ‘Claims’ at the sub-menu. Press enter. Tab to the S/LOC field and type SB6001. All claims in this S/LOC will be reflected in the ‘Claim Summary Inquiry’ screen.
– Following medical review, if there is a difference on the Remittance Advice between the submitted charges and the agency’s payment, the provider can access the Remarks section to determine the reason for any denials/down codes of claim. At the DDE Main Menu, select 02. Press Enter. Select 26 and press enter. Enter page number ‘04’ and press enter. Medical Review remarks are located on page 04. If a review note is not available on this page, contact the PCC for assistance.

Good Luck!!! CP

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