ADRs in SPOT

When a claim is selected for medical review, an Additional Documentation Request (ADR) is issued to obtain supporting medical records and verify that payment is appropriate. The ADR letter is mailed to the provider’s address on file with Medicare and outlines the specific documentation required as well as the submission deadline. Per CMS guidelines, providers must respond within 45 days of the ADR date.

SPOT has several features to assist with the medical review ADR process:

1. Claims > Medical Review Claims 
   This feature will provide the ADR details and a PDF version of the letter that was mailed. 
2. Submit Documents > Medical Records/ADRs 
   This feature provides the ability to reply to the ADR by uploading and submitting the supporting documentation along with a copy of the ADR letter.
3. Submit Documents > Submission History 
   This feature will provide the status of Medical Review submissions including a PDF file of the submission letter for 90 days after the submission date. 

Details and screen images for each feature are available in the SPOT User Guide.

If you are not yet experiencing the many benefits of SPOT, visit How to register for SPOT and begin the enrollment process today.