Additional Documentation Request (ADR) Process
When a Medicare claim is selected for review or when additional documentation is needed to complete the claim, an ADR letter is generated. The letter asks that you send documentation to verify that items on your claim meet policy requirements, are coded correctly, and are paid based on Medicare guidelines. ADRs can be selected for pre-payment or post-payment audits.
The letter includes:
- Specific list of items billed on the claim
- Type of documentation requested
- Specific timeline in which to respond
- Contractor requesting information
- How to send a response
Any of these contractors may send an ADR:
- CGS
- Comprehensive Error Rate Testing (CERT)
- Recovery Audit Contractors (RAC)
- Supplemental Medical Review Contractors (SMRC)
- United Program Integrity Contractor (UPIC)
- Office of Inspector General (OIG)
CGS and UPICs use a 3-digit ADR number on the letter. CGS places the ADR number just below the claim line details. The UPICs place the number at the end of the documentation requirements section.
Our ADR Online Tool allows you to enter the CGS or UPIC ADR number to view who requested the information and what documentation you need. You'll get specific information based on your individual ADR number, plus helpful resources.
- Check your letter for the exact number of days you have from the letter date to send your documents.
- Send your documents to the Medicare contractor identified in the letter.
- Use the ADR letter as the cover sheet on top of your documents. Don't use your own cover sheet because our system won't recognize it, which could delay your response.
- If you are missing the ADR letter and can't provide it as the cover sheet, clearly indicate "ADR Response" and include the following on your cover sheet: Medicare Beneficiary Identifier (MBI), claim number, and dates of service.
- Clearly label the documents you send. You can use our Claim Documentation Cover Sheets as divider sheets and place it in front of the documents.
- Provide all requested documents. If your ADR letter requests 6 documents, make sure your response has all 6 documents.
- Make sure your documents are clear and readable.
- Send separate responses for each claim. Don't combine them.
- Send copies, not original documents. Medicare contractors won't return your documents following the review.
Resources:
- ADR Online Tool
- ADR Timeliness Calculator
- Medical Review Pre-/post- Payment Contractor Information
- Auditing Entities Chart
Revised: 05.19.2025