Reason Code 56900: Auto Denial, Requested Records Not Submitted

Medical records were not received in response to an Additional Documentation Request (ADR) in the required time frame; therefore, we were unable to determine medical necessity.

To Prevent This Denial

• Monitor your claim status on Direct Data Entry (DDE). If the claim is in status/location SB6001, the claim has been selected for review and records must be submitted.
• Aim to submit medical records within 30 days of the ADR date. The ADR date is in the upper left corner of the ADR request. The claim will auto deny on day 46.
• Gather all information needed for the claim and submit it all at one time
• Submit medical records as soon as the ADR is received
• Attach a copy of the ADR request to each individual claim
• If responding to multiple ADRs, separate each response and attach a copy of the ADR to each individual set of medical records. Ensure each set of medical records is bound securely so the submitted documentation is not detached or lost.
• Do not mail packages C.O.D.; we cannot accept them
• Return the medical records to the address on the ADR. Be sure to include the appropriate mail code. This ensures your responses are promptly routed to the Medical Review Department.