Glossary / ADR
ADR Additional Documentation RequestADR (Additional Documentation Request)
A Medicare reviewer's written request for the records behind a claim; miss the deadline on the letter and the claim is denied without review.
An Additional Documentation Request (ADR) is a letter from a Medicare contractor, usually your DME MAC, asking for the medical records that support a claim it has selected for review. The claim is not denied when the letter arrives. It is on hold until the reviewer sees the documentation, and the outcome depends on what you send and when.
ADRs come out of prepayment review (the claim is suspended before payment), postpayment review (the claim was paid and is being re-examined), and programs such as Targeted Probe and Educate. The letter lists the claim, the dates of service, and the documents the reviewer wants. For DME that usually means the Standard Written Order, the face-to-face and clinical notes, and proof of delivery.
CMS's Program Integrity Manual gives suppliers 45 calendar days to respond to a MAC request, and the deadline is printed on the letter. If nothing arrives by then, the claim is denied for non-response and the reviewer never looks at your file. Respond through the MAC portal, esMD, fax, or mail, with the ADR letter or a cover sheet on top so the packet routes to the right claim.
Common questions
How long do I have to respond to an ADR?
The letter governs. CMS's manual sets 45 calendar days for MAC requests, and the DME MACs publish timeliness calculators that count from the letter date. Calendar it the day the letter arrives and start chasing practitioner records immediately, since those are the slowest piece.
What happens if I miss the deadline?
The claim is denied for non-response without any review of the documentation. You keep appeal rights, but you have turned a records request into a formal appeal with its own clocks.
Can software help with an ADR response?
Yes. AffirmDME reads the ADR letter against the documents already on the case, recommends what to enclose, and drafts an editable cover letter.
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Sources: CMS Program Integrity Manual, Chapter 3 (3.2.3.2 Time Frames for Submission) · Noridian JA DME: How to Respond to an ADR . Definitions summarize public Medicare policy and are not legal or billing advice.
More terms
- Prior authorization
- Affirmation and non-affirmation
- UTN — Unique Tracking Number
- SWO — Standard Written Order
- Face-to-face encounter
- DME MAC — Durable Medical Equipment Medicare Administrative Contractor
- Jurisdiction
- PTAN — Provider Transaction Access Number
- NPI — National Provider Identifier
- MBI — Medicare Beneficiary Identifier
- LCD — Local Coverage Determination
- NCD — National Coverage Determination
- Policy article
- HCPCS — Healthcare Common Procedure Coding System
- Length of need
- Prior authorization exemption
- Competitive bidding
- CMN and DIF — Certificate of Medical Necessity and DME Information Form
- Proof of delivery
- TPE — Targeted Probe and Educate
- Prepayment review