Additional Documentation Requests (ADRs)

12.10 –Additional Documentation Requests (ADRs) (Rev. 13678; Issued: 03-12-26; Effective: 04-13-26; Implementation: 04-13-26) This section applies to Medicare Administrative Contractors (MACs) and Comprehensive Error Rate Testing (CERT) as indicated. A. General The CERT review contractor sends the ADR to the billing provider/supplier. If the CERT review contractor determines that documentation is missing or insufficient to make a determination on a claim, a subsequent ADR may be sent to the billing provider/supplier, the ordering/referring provider, or a third-party, as appropriate. B. ADR Letters When requesting medical records from providers, suppliers, and third parties, the CERT review contractor uses CMS approved ADR letters. The CERT review contractor sends ADRs in Spanish to providers in Puerto Rico and upon request to providers in other regions.