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.
The ADR is sent to a provider's practice address on file with Medicare. To ensure you are receiving your ADR to the correct address, be sure to update your 'Medical Review Correspondence Address' in the Provider Enrollment, Chain, and Ownership System (PECOS).
Novitas Solutions accepts medical records via:
Electronic submission of medical documentation (esMD)
Fax
Novitasphere, our
free, secure internet portal (
JH) (
JL)
US Mail
CD/DVD
Once an ADR is received a provider should do the following:
Collect all requested documentation
Verify all documentation requested is included in your submission
Attach the original ADR request as the cover sheet to the records
Service specific prepay review
Prepay probe
Post payment probe - we will provide a fax cover sheet (ADR is not generated in the Multi-Carrier System). Providers will attach all requested documentation utilizing the fax cover sheet.
If you are responding to multiple ADR requests, clearly separate the documentation for each claim. You will need to submit the first page for each ADR letter or individual fax cover sheet separately with documentation that pertains to that beneficiary. Multiple responses sent together, but not separated, may result in the documentation being imaged as one claim or claim may be rejected completely.
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 us.
Fax ADR responses for all regions to 1-877-439-5479 (24 hours a day/7 days a week).
Faxes should not exceed 200 pages.
A copy of the ADR letter must accompany the fax.
Submit only documentation for date of service and procedure code requested.
Providers may submit medical records via password protected CD/DVD.
Include the following in your email:
Subject: CD/DVD password, provider name.
Body of email: Provider name, Provider Transaction Access Number (PTAN) and the DCN/ICNs applicable to the CD/DVD, and the password.
If you are responding to multiple MR ADR requests, clearly separate the documentation for each claim.
Save time and money by electronically submitting medical records and requesting comparative billing reports through Novitasphere. Submit your PHI/PII securely and with confidence. For more information, please visit the Novitasphere (JH) (JL) page of our website.
Jurisdiction |
State |
Address |
JH ADR Response |
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 |
All States |
Novitas Solutions, Inc.
Part B Medical Review/Manual
Development Response
P.O. Box 3007
Mechanicsburg, PA 17055-1800 |
Physical address for mail that cannot be sent through a P.O. Box, including overnight delivery/certified mail:
Novitas Solutions, Inc.
Attention: Medical Review/Medical Records Submission
2020 Technology Parkway, Suite 100
Mechanicsburg, PA 17050
When submitting hardcopy medical records, please consider the following suggestions:
Please do not use staples or paperclips.
Each packet should be bound with a rubber band with the appropriate ADR on top and the correct medical records.
Please avoid mixing single and double-sided documents.
Return the medical record to the correct address listed on the ADR.
Please do not include any other correspondence or claims that do not pertain to your ADR.
Make sure the physician’s signature is legible or include an attestation of signature.
Resource:
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