Our agency recently had an additional information request (ADR) for a claim for the edit reason 5053P. How can we figure out what this edit reason code means?
Providers are able track the reason claims are selected by the first reason code that appears on your ADR message. After selecting your claim in the Fiscal Intermediary Standard System (FISS), press “F1” to access the Reason Code Inquiry Screen. Enter the reason code in the “REAS CODE” field and press “Enter”. At the bottom of the screen, under the ADR message, is the description of the edit requirements (ie—why your claim was selected for medical review). See the example below: Note: you may need to press the F6 key to scroll forward on the screen to review the entire narrative. (Oct. – Dec.
Related Questions
- If a plan determines that a claim does not provide sufficient information, must the plan take an extension of time and request additional information from the claimant?
- What documentation should be included when an Additional Development Request (ADR) form is received from Highmark Medicare Services?
- What is necessary when submitting medical record documentation for an Additional Documentation Request (ADR)?
