Railroad Medicare Implemented Automated Calls to Assist Providers with ADR Responses

Railroad Medicare began making automated calls to providers in an effort to increase timely responses to Medical Review Additional Documentation Requests (ADR).

We will make an automated courtesy call as a reminder to any provider who has not responded to a request for medical records within 30 days. The call will provide basic information about the pending request, including the provider’s name, the claim control number (ICN), the date of service, the date the ADR letter was mailed to the provider and the date the claim will deny for failure to respond.

Providers that receive a call reminder should ensure their response to the referenced ADR is returned to us before the denial date given in the call. We continue to urge providers to submit the requested documentation as soon as possible after the receipt of an ADR letter. Prompt response helps to ensure timely review of claims.  

When you receive a Medical Review Additional Documentation Request (ADR) for one or more claims that you have submitted to Railroad Medicare for payment, it is important that you comply with the following instructions.

  1. Provide the documents listed on the ADR and any related physician’s orders. Make sure the physician's signature is legible or include an attestation of signature
  2. Include a copy of the ADR letter with your documents
  3. When returning ADR responses for multiple claims, be sure to pair each ADR letter with the corresponding documentation. Pairing these documents ensures the documentation for each request letter is correct for each date of service requested.
  4. Include a completed Medicare Medical Review ADR Response Cover Sheet. Use one ADR Response Cover Sheet for each ADR letter/claim.
  5. Return your documents using one of the following methods. Do not submit by more than one method as a duplicate response slows down the documentation review process.
    • Upload your ADR response through our eServices, a free, self-service portal located at www.PalmettoGBA.com/eservices. eServices lets you upload your ADR response electronically, eliminating the need to fax or mail documents and packages. To participate, you must have an EDI agreement on file with Railroad Medicare. When you upload a document, you will receive a message when the form is submitted and another message with the Document Control Number (DCN) when the form has started processing. You can use the DCN to look up form processing status and view your submitted forms.
    • Submit your ADR response via the esMD (Electronic Submission of Medical Documentation) mechanism. For more information about esMD, please see the CMS website at www.cms.gov/esmd
    • Fax your ADR responses to 803-264-8832
    • Mail your response to
      • Palmetto GBA Railroad Medicare
        Medical Review
        PO Box 10066
        Augusta, GA 30999

  6. Return your ADR response to Palmetto GBA within 45 days of the date on the ADR letter. The claim will automatically deny by the 46th day if a response has not been received.
  7. Once ADR responses are received, CMS requires Palmetto GBA to complete medical review of the documentation within 30 days. Do not resubmit ADR responses to Palmetto GBA.
  8. Do not submit replacement/duplicate claims for the ones pending in medical review. The submission of replacement/duplicate claims will result in claim denial, rejection or recoupment and will prolong the medical review process.
  9. When the claim is finalized, the claim will receive a status of paid, denied or rejected
    • If you disagree with a denial or payment, you can request a redetermination. Information on requesting a redetermination can be found in Railroad Medicare Appeals
    • If the claim was rejected as unprocessable with remittance message MA130, you must submit a new corrected claim 

 

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Provider Contact Center: 888-355-9165

IVR: 877-288-7600

TTY: 877-715-6397

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