This notice is an update to Provider Notice 06-066 dated August 2, 2006 and PA Provider Notice 03-095 dated July 24, 2003.  There are additional instructions for providers  regarding ADR (Additional Development Request) letters.

Purpose
The purpose of this notice is to advise the provider community of the opportunity to update their Medical Review (MR) contact information in the Fiscal Intermediary Shared System (FISS) and the importance of submitting accurate, complete and timely supporting documentation when responding to Additional Development Requests (ADRs).

Highmark Medicare Services continues to analyze trends to identify recurring, avoidable denials and develop training for the provider community that will aid in submitting claims properly.  Highmark Medicare Services has seen a significant increase in the number of denials resulting from a lack of response to ADRs, incorrect  provider mailing addresses in FISS, missing documentation,  and multiple records of same beneficiaries for different dates of service, and/or multiple records of different beneficiaries submitted together with only one ADR letter attached.  In addition, providers are submitting the FISS screen print in place of the preferred system generated ADR letter.

In order to eliminate unnecessary denials, and save valuable time and resources, please review the following items:

• Code claims correctly to avoid suspension for medical review.
• Use the ADR request letter as a guide when compiling the information for  mailing.
• It is the responsibility of the provider submitting the claim for payment to obtain all the requested documentation, regardless of where the records are kept.
• Thoroughly review the ADR letter to ensure that all items requested are submitted completely.  
• Do not send part of the records while you are waiting for the rest.  The first record submission received will be reviewed as the complete submission. 
• Attach all requested documentation for the service period requested to the original system generated ADR letter.
  • We do not recommend submitting medical records with the FISS screen print ADR letter.  This is because some providers send a FISS screen print that does not contain the necessary information to identify the suspended claim.
• Keep ADR documentation separate for different service periods when multiple service periods are requested.
  • We recommend separately stapling medical records with colored paper or tabs between claims to further assist the mail handlers who must identify and move large numbers of claims individually in FISS. 
• When medical records are submitted, each medical record is to have a copy of the original ADR letter for that beneficiary attached to the medical record submitted.  Failure to do so may result in misfiled records and delays in processing.
• When you receive an ADR, respond within thirty (30) days to avoid denials.
• Appeals and Benefit Integrity Units are separate from Medical Review.  Records are not passed from one unit to another.

The ADR and all requested documentation may be submitted by:

Changing the ADR mailing Address
A provider may contact Highmark Medicare Services directly to request an update of their MR contact information in FISS.  This request will apply only to the MR address field in the FISS provider file.  To request this update the provider should compose a letter on company letterhead asking that their mailing address be changed.  This letter should include:

• Provider's name and Medicare ID number
• List the address to which any MR mailings, ADR letter, etc. should be sent
• Title of the position to whose attention any mailings should be directed, i.e.  Medicare Compliance Officer.
• Contain the signature of an authorized employee/representative of the provider who is requesting the change.

Send letter to:

Highmark Medicare Services
Attention: Mark McGinley
120 Fifth Avenue Place, Suite P5301
Pittsburgh, PA 15222-0399

Please be advised that other requested changes to FISS contact information must be submitted to the Centers for Medicare and Medicaid Services (CMS) using their 855-A enrollment form.  The 855-A enrollment form is located on the CMS web site with instructions for requesting such a change.

References
Provider Notice 03-095 and Provider Notice 06-066

Questions
If you have any questions regarding this bulletin, please contact the appropriate Customer Contact Center at: