What documentation should be included when an Additional Development Request (ADR) form is received from Highmark Medicare Services?
The following physician documentation should be submitted to Highmark Medicare Services when an ADR is received: • physicians’ orders • the results of any tests used to diagnose the neurological or musculoskeletal disease for which IVIG was initiated (muscle-nerve biopsy, electrophysiological motor-sensory nerve conductions (EMG), CSF studies and any other ancillary tests such as serum immunoprotein); • objective clinical assessment including functional status at the time of diagnosis and/or at the time IVIG was initiated; • specific signs and symptoms, level of functional impairment and clinical data including laboratory test results supporting the diagnosis code(s) used for the date of service of the claim that is submitted for payment; • the choice of IVIG over other treatments; • the results of all testing/services rendered; • the patient’s response to the treatments; • the medication administration form; • previous treatment failures, when applicable; • any attempt to stop IVIG tr
Related Questions
- 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)?
- If a facility does not respond to an Additional Development Request (ADR), can they appeal the denial?
