An ADR (Additional Development Request) is a request for medical documentation to ensure proper payment for Medicare services provided. Claims are randomly selected based on specific edits and parameters set by the Medicare Contractors. This documentation must be received on or before the 45-day due date. Failure to do so will result in denial code 56900 which indicates documentation was not received or was not received in a timely manner.
Redetermination Appeal vs Reopening Request
In most cases, when a claim is denied and the provider disagrees a redetermination appeal is submitted, which is the first level of the Medicare appeal process. However, a reopening request can be used to correct minor errors or omissions to a previously processed claim and claims denied due to timely filing.
Reopening request can be made within 120 days from the date of the initial determination. And it can take up to 60 days for the request to process and payment determination.
NOTE: If a reopening request is submitted after 120 days, the Medicare Contractor may allow a reopening at their discretion or deny the request if no good explanation is provided for the late filing.