Responding to a Palmetto GBA Additional Documentation Request

Have you received a request for medical records from us? Here are a few things to keep in mind when responding to a Palmetto GBA Additional Documentation Request (ADR):

• Responding timely to your requests is key to preventing your claims from denying 
  • When submitting requested documents via US mail/Fed, etc., please allow extra time for delivery and processing
• When submitting documentation, please be sure to only submit medical records for 1 claim per DCN. Attaching multiple records to a single DCN will delay your claim from processing and potentially cause other claims to deny for no documentation.  
• Submitting your point of contact (POC) with your records is imperative to assure our medical reviewers can reach the appropriate party for easily curable errors identified during the review process
• Education is available during any point of the review process from our Medical Review department. If you have completed the review process and your 1:1 final education with Medical Review our Provider Outreach and Education Department can assist with any further needs. 

Please visit our Targeted Probe and Educate (TPE) webpages provided below for more resources:

• JJ Part A TPE webpage
• JM Part A TPE webpage
• Access TPE Letters Electronically: Job Aid
• Claim Selection Process for Targeted Probe and Educate: S B6000 vs. S B6001
• Targeted Probe and Educate Process Module