Additional Development Request (ADR)
Faxing or Mailing Additional Documentation
The PWK Fax/Mail Cover Sheet is available on the Forms page of our website.
Complete all fields on the cover sheet. CGS will return PWK cover sheets with missing or inaccurate information, e.g., HICN.
No modification may be made to this cover sheet.
We will not return any documentation that accompanies a rejected PWK cover sheet.
Important: You must send the appropriate PWK cover sheet and medical documentation separately for each individual claim. Fax your documentation separately (using a separate fax cover sheet for each claim).
Submit your claim first, then fax your PWK documentation. If the PWK segment is completed and additional documentation is needed for adjudication of the claim, we will allow 7 calendar 'waiting' days (from the claim date of receipt) for the documentation to be faxed or 10 calendar 'waiting' days for mailed documentation.
Claims submitted with a PWK segment that would not otherwise suspend for review and/or additional development will be processed in accordance with our established procedures and will not be held for the 7- or 10-day waiting period.
Join Electronic Mailing List
Print
Bookmark
Facebook
YouTube
LinkedIn
CGS Medicare Mobile App