NGSConnex User Guide

Respond to ADR

If you receive an ADR for a claim that you have submitted to National Government Services or payment, it is important that you respond in a timely manner. Include all records necessary to support the services for the dates requested.

  1. Click the ADR button from the NGSConnex homepage.

Select a Provider panel

  1. In the Select a Provider panel, click the Select button next to the applicable provider account.

Image of ADR panel displayed in NGSConnex with a yellow arrow pointing to the ADR Summary button and Filters.

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ADR Summary

The ADR Summary will display any claim(s) that have been selected for review by Medical Review or Claims in the 'Awaiting Documentation' status for the provider selected.

You can search for other claims selected for MR ADR in the previous 24 months or for the claim you would like to respond to by using the filter options. You may filter by any of the following:

  • ADR From Date
  • ADR To Date
  • ADR Status
  • Claim Number
  • Document Number

Image of ADR Summary tab in NGSConnex with a yellow arrow pointing to the ADR Summary tab, and Filters.

The following information will be provided:

  • Claim Number
  • From Service Date
  • To Service Date
  • Beneficiary Name
  • ADR Date – Date the ADR letter was mailed
  • ADR Status – ‘Awaiting Documentation’ or ‘Documentation Received’
  • Due Date – the system will display the date the response to the MR ADR is due
  • ADR Type- Claims or Medical Review
  • Document Number – This is the 25 alpha-numeric code found on the MR ADR letter.
  • Nurse Review Decision – the outcome of the medical review; this does not apply if the ADR type is Claims.
  • Claim Finalized Date – this is the date the claim finalized in the claims processing system. If you would like to export a list of claims that have received a MR ADR you can click the ‘Export to Excel link.

If you would like to export a list of claims that have received a MR ADR you can click the ‘Export to Excel link.

Export to Excel link
 

  1. In the ‘Actions’ column, the following will display:
    • Red Exclamation - “You failed to respond to the ADR selected in a timely manner. Please review your remittance advice to determine how to resolve the denial.”
    • Blue Exclamation – “A determination will be issued within 30 calendar days of receipt of the requested documentation. You can check status in the ADR Details section by selecting the claim number hyperlink.”
  1. If you would like to view details regarding the MR ADR, in the Claim Number column, click the Claim Number hyperlink.
    • Medical Review ADR Details
    • ADR Letter - the ADR letter will display, if the ADR was issued on or after 8/15/2023, otherwise, the ADR letter content will display
    • Claim Lines – the specific claim lines associated with the MR ADR will display

      A screen shot of the ADR summary in NGSConnex with a yellow arrow pointing to the Claim Number hyperlink.

  1. Review the ADR Details section to determine what claim lines are being reviewed or to determine what additional documentation is being requested.

    A screenshot of the ADR Details page with a yellow arrow pointing to the ADR Letter link in the Left Side navigation.

     
    1. Select the Respond to ADR button.

    1. Review the information displayed in the ADR Information section and verify you have selected the correct claim.
       
    1. Click the Verify Information button.

    ADR Information

    1. In the Attachments section you will upload all supporting documentation you would like to submit with your response. You have the option to drag and drop and attachment or browse your computer for an attachment.
       
    2. We will accept most common file formats. You should submit only documentation relevant to the specific services/dates in your request for additional documentation and submit as few attachments as possible. You can combine multiple supporting documents in each attachment. By doing so, you will maximize the use of each attachments size (25 MBs) and minimize the number of attachments submitted with our response. The attachment name should be comprised of letters and numbers. If an Attachment Name contains any special characters, you must rename the attachment.

    Image of Step 2 Attachments with a yellow arrow pointing to the documents previously attached. A yellow arrow is pointing to the next button to move forward.
     

    1. Your attachments will display and you can verify that you have added all of the applicable attachments. If an attachment was added in error you may delete it prior to submitting your response by selecting the delete icon.
       
    2. Click the Next button to move forward.
       


     

    1. If you are ready to transmit your response to National Government Services, select the Submit button.
       

    Select the Submit button.

    1. A message will display notifying you that your ADR has been submitted successfully. In addition, a confirmation email will be sent to the email address associated with your User Profile.
    2. Select the Close button to return to the list and respond to another ADR or select the Back button to review your response.
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    Revised 4/5/2024