No Response to ADR

12.10.1 – No Response to ADR (Rev. 13890; Issued: 07-30-26; Effective: 08-28-26; Implementation: 08-28-26) If documentation is not received within 60 days of the first ADR, the claim is a no documentation error with error code 99. Error code 99 claims are posted to the C3HUB on the 61st day from the date the first ADR was sent and will appear in the next MAC feedback posting. For claims with error code 99, the MACs may proceed at their discretion by doing one of the following: i. Contact those providers who have failed to submit medical records and encourage them to submit the requested records to the CERT review contractor for review. The MACs should not complete feedback while they are working with the provider to obtain documentation and/or the CERT review contractor is reviewing the claim; ii. Complete MAC feedback in accordance with section 12.4.3 of this chapter and collect the overpayment immediately in accordance with section 12.5 of this chapter; or Regardless of the option selected above, the MAC must complete feedback at least 30 days prior to the deadline to submit late documentation posted on the C3HUB. The MAC shall not contact any provider or supplier selected for CERT review until 30 days after the first CERT ADR has been reported on the C3HUB. The MAC may contact the third party and encourage them to send the needed medical record documentation to the CERT review contractor. When contacting providers or suppliers, the MAC shall remind them to include the cover sheet included with the CERT request or the CERT claim identification number at the top of the medical record. The MAC can download a cover sheet from the C3HUB if needed.