Additional Development Request (ADR) Process
Program
Integrity Manual (CMS Pub. 100-08), Ch. 3, §§3.4.1.2 and 3.11.1.4 
Providers that have claims selected for prepayment review will receive an Additional Development Request (ADR) notice via the Fiscal Intermediary Standard System (FISS). It is very important that you establish a procedure in your office to monitor claims in the ADR status/location on a regular basis (recommended at least one time per week) and send the requested information within the time frame specified to ensure timely review and processing of the claim.
Instructions about how to access the ADR information online through FISS access can be found in the Inquiry Menu section of the FISS Reference Guide.
The Additional Development Request (ADR) Quick Reference Tool provides an overview of the ADR process.
Claims that receive an ADR will appear in FISS status/location S B6001. Providers must submit additional documentation to support the services billed within 30 days. Once the requested documentation is received, the claim is moved to status/location S M50MR or S M51MC. A nurse reviewer examines the beneficiary's medical records submitted by the provider and makes a payment determination.
If the requested ADR documentation is not received by the 45th day, the claim is automatically denied for insufficient information. Reason code 56900 displays on the claim. The charges denied are included in the provider's individual denial statistics.
Page last updated: June 16, 2008
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