eServices eForm: Additional Documentation Response Form (Medical Review)

eServices users can respond to Palmetto GBA Medical Review Additional Documentation Request (ADR) letters securely through our eServices portal. The eServices MR ADR Response form allows you to upload supporting documentation for the claim that is being reviewed. A separate MR ADR Response form should be submitted for each ICN that is being reviewed.

You may attach an unlimited number of PDF attachments to each ADR form. Each attachment can be up to 40 MB in size. The total size of all attachments on each ADR form can be no more than 150 MB. The forms and attachments are automatically entered into Palmetto GBA's workflow. This makes form processing more efficient and cost effective.

When you upload a document, you will receive a message in eServices when the form is submitted and another message in eServices with the Document Control Number (DCN) when the form has started processing. You can use the DCN to look up form processing status and view your submitted forms in eServices.

To begin, access the Forms tab in eServices, select 'Medical Review' from the 'Select a Topic' drop-down menu and select the link to the MR ADR Response form which displays in blue.

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Provider Contact Center: 888-355-9165

IVR: 877-288-7600

TTY: 877-715-6397

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