PROBE AND EDUCATE ISSUES

Medical Review Additional Documentation Requests (ADR) have begun.  We were first notified in the fall about this new type of ADR that selects episodes that began after August 1, 2015 for review by intermediaries.

 

However, a recent development has occurred. Because of the systems in place used (FISS DDE and other data intelligence/analytics) some agencies are going to be seeing more than the 5 requests that were initially explained.  Some agencies are reporting between 10 and 40 claims being selected.

 

To check on the status of a claim that has been selected, you will need to login to FISS and perform an inquiry.  The claims will be suspended in status/location S B6001. This status will be updated nightly.  If you see more than five claims, check the following day as intermediaries are working to correct the issue.   Please contact us with any questions.

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