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Additional Development Request (ADR)Claim Payment Timeframe

The soonest CGS can release a claim for payment is 14 days after the date of submission (this includes the day of submission and 13 days after that date). This is also called the payment floor. However, per the CMS Medicare Claims Processing Manual (Pub. 100-04, chapter 1, section 80.2.1.1), all Medicare Administrative Contractors, including CGS, have up to 30 days to process clean claims without paying interest.

A clean claim is defined as a claim that does not have any circumstance or defect that would inhibit timely payment from being made. In other words, it is correct, complete, and includes all of the information CGS requires in order to process that claim. If CGS has requested medical records in order to process a claim, that claim is not considered "clean."

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