New Timeframe for Response to Additional Documentation Requests

CMS review contractors (MACs, ZPICs, Recovery Auditors, the Comprehensive Error Rate Testing contractor and the Supplemental Medical Review Contractor) may not be able to make a determination on a claim they have chosen for review based upon the information on the claim, its attachments or the billing history found in claims processing system or Medicare’s Common Working File (CWF). In those instances, the CMS review contractor will solicit documentation from the provider or supplier by issuing an Additional Documentation Request (ADR). The MAC and ZPIC shall notify providers that the requested documentation is to be submitted within 45 calendar days of the request. Reviewers shall deny claims for which the requested documentation was not received by day 46.