Responding to an Additional Documentation Request or Pre-Claim Review Request via Fax or Mail

Published 07/21/2023

Medicare providers should respond to an additional documentation request (ADR) or pre-claim review (PCR) request by fax, U.S. mail or courier service.

How to Submit ADRs

  • Include a manifest/list with medical records submitted and send the medical records in secure packaging to ensure the security of medical records — do not send original records
  • If responding to multiple requests in a single package, ensure each response is clearly separated. If responding to more than one date of service on the same beneficiary, send a separate response for each request. Include a manifest or list identifying each ADR response sent.
  • Attach a copy of the original ADR with the original ADR barcoded letter to each individual ADR response
  • Use one staple or elastic band per record to attach the documentation and ADR together. Do not use paper clips as they can become dislodged.
  • Do not punch holes in medical records, as this may obscure valuable information
  • Submit the medical records to the appropriate address listed below or on the ADR 
  • Do not include any correspondence other than ADR responses to the medical review department
  • The Palmetto GBA medical review department developed a Responding to a Home Health Additional Documentation Request (ADR) checklist (PDF) and a Responding to a Hospice Additional Documentation Request (ADR) checklist. Please complete this checklist and include it when responding to an ADR. To access this checklist, select the PDF document above.

For Targeted Probe and Educate (TPE) Only
Please remember to submit the contact information for the person(s) who will be the point of contact for the reviewer to contact by phone for any missing information or to schedule an educational session upon completion of the 20–40 claim sample.

For PCR Requests
There is a pre-claim review form that can be filled out when submitting PCR requests by fax or mail — JM HH Pre-Claim Review Submission Request Form. Please complete this form when submitting PCR requests this way. 

Special Instructions for Physical Files

  • Unfortunately, we are not able to accept packages on a C.O.D. basis. Please make sure that you have sent packages with the shipping prepaid.
  • If you send a CD or DVD for medical review or appeal documentation, please send the entire document (including documents with multiple pages) 
    • Preferred File formats: PDF or TIFF
    • Do not send an executable file (.exe) or include an .exe program with the PDF or TIFF file
    • SecureZip: be sure the file is zipped using the FIPS 140 encryption algorithm
    • Spreadsheets in excel converted to PDF
    • When using password protect files on Adobe Security feature (separate from password protect on disk), please also provide the password
    • Email passwords for SecureZip or Adobe Security to DISKINFO@Palmettogba.com
    • Please don't create a PDF or TIFF file of each page. One PDF or TIFF file per record is acceptable.

Where to Send Files

U.S. Postal Service Courier Service

Medicare Part A Medical Review
Mail Code: AG-230
P.O. Box 100238
Columbia, SC 29202–3238

OR

Home Health Review Choice Demonstration
Mail Code AG-760
P.O. Box 100131
Columbia, SC 29202–3131

Medicare Part A Medical Review
Mail Code: AG-230, BLDG 1
2300 Springdale Drive
Camden, South Carolina, 29020–1728

OR

Home Health Review Choice Demonstration
Mail Code: AG-760, BLDG 1
2300 Springdale Drive
Camden, South Carolina, 29020–1728

Where to Send via Fax

  • Records can be faxed to (803) 699–2436 (for JM MR HHH ADR only)
  • Records can be faxed to (803) 419–3263 (RCD HH Pre-Claim Review and ADR Responses)

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