Additional Documentation Request Letter (ADR) Example

ADR Letter from Connolly

This is an Additional Documentation Request Letter (ADR) letter from Connolly to a hospital in Georgia. It only requests 5 records, but is only the first they've received, and is dated Feb 25, 2010.

The letter requests documentation for five claims, stating that DRG Validations are being conducted for the following MSDRGs --

• MSDRG 981 - OR Procedure unrelated - RW 5.04, Rank 134, ALOS 14.6 - claim shows 7 day stay.
• MSDRG 386 - Inflammatory Bowel Disease - RW 1.04, Rank 343, ALOS 5.4 - shows 6 day stay.
• MSDRG 574 - Skin Graft &/or Debridement - RW 1.91, Rank 352, ALOS 8.9 - shows 5 day stay.
• MSDRG 574 - Skin Graft &/or Debridement - RW 1.91, Rank 352, ALOS 8.9 - shows 4 day stay.
• MSDRG 357 - Other Digestion System OR Procedure - RW 2.12, Rank 468, ALOS 7.7 - shows 3 day stay.

Download the letter, HERE. (PDF Format, 3 pgs, 157KB)