Receiving and Responding to a Palmetto GBA Additional Documentation Request for Postpayment Review

Published 04/28/2022

You may receive an Additional Documentation Request (ADR) requesting medical record documentation associated with a claim selected for a service specific postpayment review. You will receive an ADR for each claim selected, which will outline the information below specific to the service and claim selected for review.

Reason for Selection
As the RRB Specialty MAC, Palmetto GBA is tasked with preventing inappropriate Medicare payments. This is accomplished through provider education, training and the medical review of claims. This section in the ADR will include why the claim was selected for review.

Action: Additional Documentation
As per the Social Security Act, Sections 1815(a), 1833(e), and 1862(a)(1)(A), providers are required to submit medical record documentation to support claims for Medicare services to the MAC program upon request.

Point of Contact
When submitting the requested medical record documentation in response to the ADR, please submit point of contact (POC) information for your agency, including name and phone number, for follow up during the review if missing documentation is identified. 

When: Within 45 days
Please provide the requested documentation within 45 days of the date of the ADR. As per the Medicare Program Integrity Manual Chapter (PDF), Medicare contractors have the discretion to grant an extension to providers who need more time to comply with the postpayment medical record request. If you are unable to reply within the required timeframe, please submit an extension request to Palmetto GBA using your preferred submission method, as outlined at the end of the article. Please include the required information with your extension request, addressed to MR ADR Extension Request:

  • The identifying claim information (date of service, claim number, beneficiary name/MBI)
  • The identifying provider information (provider number, provider name and name of requestor)
  • In addition to the submission methods listed below, you may also reach out to the Provider Contact Center at 888–355–9165 for assistance

If the provider fails to send the requested documentation or request an extension within 45 days, the review determination will be to deny the claim as not reasonable and necessary as per the Social Security Act, Sections 1815(a), 1833(e), and 1862(a)(1)(A) and the claim will be adjusted to initiate overpayment recoupment actions for these undocumented services. The claim adjustment will generate a demand letter as per Section 935 of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) which provides limitations on the recoupment of Medicare overpayments. For more information please refer to Section 935 Overpayment Recoupment Process.

This section of the ADR will include a list of recommended documentation to submit in response to the ADR. The records should be submitted to Palmetto GBA Railroad Medical Review department via one of the methods listed at the end of this article. Providers are responsible for obtaining supporting documentation from third parties (hospitals, nursing homes, suppliers, etc.). Patient identification, date of service and provider of the service should be clearly identified on the submitted documentation. We recommend you include the original ADR with your response.

Medicare requires that medical record entries for services provided/ordered be authenticated by the author. The method used shall be a handwritten or electronic signature. If you question the legibility of your signature, you may submit an attestation statement in your ADR response. If the signature requirements are not met, the reviewer will conduct the review without considering the documentation with the missing or illegible signature. This could lead the reviewer to determine that the medical necessity for the service billed has not been substantiated. Stamped signatures are not acceptable. For more information, please refer to the Medicare Program Integrity Manual, Chapter 3 (PDF), Section

A Medical Review ADR Response Cover Sheet (PDF) is available within the Forms/Tools section of our website.

Submission Methods
Providers may submit this documentation in any of the following ways:

Via eServices Portal

Via Electronic Submission of Medical Documentation (esMD)

  • Include a copy of the ADR with your documents
  • More information on esMD can be found at

Via U.S. Mail

  • Include a copy of the ADR with your documents
  • Mail to the following:

Palmetto GBA Railroad Medicare
Medical Review
PO Box 10066
Augusta, GA 30999

Via Fax

  • Fax number: (803) 264–8832
  • Include a copy of the ADR with your documents

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