Reason Code: 56900

Error Description:

Requested medical records were not received within the 45 day time limit; therefore, we are unable to determine the medical necessity of the services billed and this claim has been denied. If less than 120 days after denial notification on remittance advice, submit records to the contractor requesting records. Do not resubmit the claim.

Avoiding/Correcting This Error

This reason code can and should be prevented. When providers receive an ADR, respond according to the date listed in the ADR. Providers should start gathering the documentation being requested immediately. This will ensure that there is adequate time to gather all the supporting documentation that is being requested so that the timeframe for submitting the information can be met. Depending on what is being requested, providers may have to go outside of their facilities to get the supporting documentation and this may require time to be received from that entity. The ADR letter you received will indicate whether you have 30 days (Claim ADR) or 45 days (Medical Review ADR) to respond.