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January 29, 2018

Additional Documentation Requests (ADRs): How and What to Send

As part of the Medical Review process, CGS requests medical records for some services prior to processing claims. A good rule of thumb is to send records which support the service and diagnosis (diagnoses) submitted on the claim as well as the medical necessity for the services.

Medical records may be sent to CGS via three routes:

  • Fax:

    Kentucky: 615-664-5964
    Ohio: 615-664-5966

  • Mail:

    CGS Administrators, LLC, Medicare Part B
    P.O. Box 20018
    Nashville, TN 37214-3685

    Or the physical address:

    CGS Administrators, LLC, Medicare Part B
    26 Century Blvd STE ST610
    Nashville, TN 37214-3685

  • myCGS Provider Portal:

    MyCGS Provider Portal

Whichever route you use to submit your records, you need to always include your ADR letter on top of the documentation that goes with each requested claim. Make sure when completing the Forms in the CGS portal you are using the correct ADR Letter Number. This ADR Letter Number assists the Medical Review department in determining where the claims should be routed. Also remember that when records are requested, they must be received within 45 days of the date of the letter. When responding to a request from CGS or from another medical review contractor (including the Comprehensive Error Rate Testing [CERT] contractor or Recovery Auditor) for medical records, please do not send the entire chart. Many requests will specify what documentation is being requested.

Medical contractors do not base their decisions on the volume of documentation submitted. It is imperative that you send all relevant documentation related to the date of service in question and send only the relevant documentation. CGS Fact Sheets are good resources and can guide you to the coverage guidelines, claim submission guidelines, and most common types of documentation that may apply.

Please share this information with your billing/medical records staff.

Additional information can be found on our website.

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