October 22, 2024
SNF ADR Issue
We are aware of an issue that caused Skilled Nursing Facility (SNF) providers to receive Additional Documentation Requests (ADRs) after their SNF 5-claim probe and educate review is complete.
CGS Action: Within approximately 2 weeks, we will identify the associated claims and release them to process for payment without medical review.
Provider Action: Review claims in the Direct Data Entry (DDE) ADR location (S B6001). If the 'USER ACT CODE' on MAP 171D = Q, we released the claim, and you don't need to respond to the ADR.
To access this information in DDE:
- Select 01 (Inquiries) from the Main Menu.
- Select 12 (Claim Summary) from the Inquiry Menu.
- Key your NPI in the NPI field and S B6001 in the S/LOC field.
- Select a claim and navigate (F8) to claim page 02.
- Navigate (F11 x 3) to MAP171D.
If you have any questions, please send an email to: J15AMREDUCATION@cgsadmin.com.