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Please remember when you are submitting a request for a redetermination, to send all the documentation that you want to include in the review. All documentation to support the services billed should be included with the request, even if you have previously submitted documentation in response to an Additional Documentation Request (ADR) request from Medical Review.

Examples of supporting documentation to submit with your request would include:

• Physician's orders

• Medical records for the dates of service billed

• Adjustment requests should include the appropriate XX7 bill on a UB-04 form

• Certification/Recertification for the appropriate dates of service

• Office records/progress notes

• Any assessment records required by the Centers for Medicare & Medicaid Services (CMS ) (i.e. Minimum Data Set (MDS), OASIS, Patient Assessment Instrument (PAI))

• Treatment plan/plan of care

• Test/lab results

• Physical therapy minutes

Please note that this is not an all inclusive list. The provider should submit any and all documentation that will support the redetermination request.