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Last Modified: 2/24/2017 Location: FL, PR, USVI Business: Part A, Part B

ADR by fax FAQ

Q. May I submit medical documentation in response to an additional documentation request letter (ADR) letter via fax?
A. Yes.
Use the following fax coversheets to submit the documentation for prepay claims ADRs:
• Prepay Claims Additional Documentation Response (ADR) fax coversheet -- Part A pdf file
• Prepay Claims Additional Documentation Response (ADR) fax coversheet -- Part B pdf file
Use the following fax coversheets when replying to a post-payment probe review documentation request:
• Post-Payment Probe Review Documentation Response (ADR) fax coversheet -- Part A pdf file
• Post-Payment Probe Review Documentation Response (ADR) fax coversheet -- Part B pdf file
The fax numbers to use are provided on the appropriate form. Be sure to select the correct form and fax number based on your line of business (Part A or Part B) and your location (Florida, Puerto Rico, or the U.S. Virgin Islands.
For reference, the forms are also located on the Medical Documentation page under "Additional documentation request (ADR) fax coversheet."
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First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.