When a claim is selected for medical review, an ADR is generated requesting medical documentation to be submitted to ensure payment is appropriate. Novitas Solutions specifies in the ADR, a description of the type of documentation that is needed to make the coverage or coding determination, along with the date of service. Make sure you review the ADR letter carefully as the ADR letter may request multiple types of documentation. CMS guidelines require providers to submit documentation within 45 days of the ADR date.
Novitas Solutions accepts medical records via:
Once an ADR is received a provider should do the following:
If you are responding to multiple MR ADR requests, clearly separate the documentation for each claim. You will need to submit the first page for each ADR letter separately with documentation that pertains to that ADR letter. Multiple responses sent together, but not separated, may result in the documentation being imaged as one claim or claim may be rejected completely.
Mailing Addresses for ADR Response and Manual Development Response (Probes):
JH ADR Reponse
Arkansas, Louisiana, Mississippi, Colorado, New Mexico, Texas, Oklahoma
Novitas Solutions, Inc.
JH Part B ADR/Medical Records
P.O. Box 3094
Mechanicsburg, PA 17055-1812
JL ADR Response
Pennsylvania, Maryland, New Jersey, Delaware, and Washington D.C.
Novitas Solutions, Inc.
JL Part B ADR/Medical Records
P.O. Box 3065
Mechanicsburg, PA 17055-1807
JH and JL-Probe Response
Part B Medical Review/Manual Development Response
P.O. Box 3007
Mechanicsburg, PA 17055-1800
For mail that cannot be sent through a P.O. Box please submit documentation to the physical address: (Includes any overnight deliveries or certified mail)
When submitting hardcopy medical records, please consider the following suggestions:
Submit ADR Documentation Electronically - esMD
Providers can submit requested ADR documentation electronically through the esMD. This process will allow providers to submit medical documentation over secure electronic means. The process is secure, time efficient and cost effective! Information on signing up for esMD can be found at the CMS website.
The fax image option allows for documentation to be submitted directly to Novitas Solutions.
Providers may submit medical records via password protected CD/DVD.
Medicare providers are now able to save time and money by electronically submitting medical records and requesting comparative billing reports through Novitasphere. Submit your PHI/PII securely and with confidence. Please visit www.novitas-solutions.com for more information.