Important Notice: Our web hosting provider recently started charging us for additional visits, which was unexpected. In response, we're seeking donations. Depending on the situation, we may explore different monetization options for our Community and Expert Contributors. It's crucial to provide more returns for their expertise and offer more Expert Validated Answers or AI Validated Answers. Learn more about our hosting issue here.

Why do some claims automatically receive ADRs and others do not?

April 26, 2017ADRs automatically

0

Posted

Why do some claims automatically receive ADRs and others do not?

1 Answer

0

Posted

A. MR is updating and changing their system edits continuously. These changes may vary with the updates of HCPCS/CPT codes, changes in CMS instructions, new or altered National Coverage Determinations (NCDs), or new Local Coverage Determinations (LCDs). Q. As a provider we are having a problem with denial of claims and the reason is usually because the documentation was incorrect. Is there anyway that a provider could set up a meeting with the Medical Review team? A. Yes and we suggest that you do ask for assitance. If you think the problem is a medical review issue please contact Janice Austin, RN at (410) 561-4158.