39700

FISS Narrative
A Medical Additional Documentation Request (ADR) has been sent to the provider. No further processing will occur on this claim until the requested data has been received from the provider.

Explanation and Suggestion
In accordance with Medicare regulations, providers have 30 days to respond to an ADR. Providers may fax the records to the number listed in the ADR or mail the records to the address provided in the letter. If no response to the ADR is received within the specified timeframe, payment on the claim will be denied. Palmetto GBA has up to 60 days from the date the documentation is received to complete a review and make a determination on the claim. Once a determination is made, the processing of the claim will be finalized.

If you receive an ADR or medical record request from Palmetto GBA, please keep the following in mind when providing medical ADR responses or submitting appeal requests.

If sending paper, avoid stapling documentation. The staples impede the scanning process. We will not change the order of your submitted documents.

If you send a CD or DVD for medical record or appeal documentation, please send these to us in a PDF or TIFF format. Please don’t PDF or TIFF each page. One PDF or TIFF file per record is acceptable. No password is required; however, if you do use a password, please ensure that we are able to link the CD with the password.

Contact Palmetto GBA JM Part A Medicare


Provider Contact Center: 855-696-0705

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