Fast facts: CERT documentation submission
The Comprehensive Error Rate Testing (CERT) review contractor sends additional documentation requests (ADRs) to providers requesting medical records to support a claim that was selected for a CERT review. The CERT review contractor follows this initial request schedule:
- Day 0: Send letter 1 requesting documentation. The provider has 45 days from this letter to furnish the requested documentation.
- Days 21-29: Telephone contact to follow-up on request and/or offer assistance.
- Day 30: Send letter 2. The provider has 15 days left to complete the request.
- Days 35-44: Telephone contact to follow-up on request and/or offer assistance.
- Day 45: Send letter 3 requesting documentation. (Response is due)
- Days 49-59: Telephone contact to follow-up on request and/or offer assistance. (Response is overdue)
- Day 60: Response is overdue. Claim is counted as non-response error.
- After non-response error is assigned (error code 99), up to five additional telephone contacts are made.
All initial ADR letters for CERT are sent to the address on file with PECOS for the provider/supplier that billed/submitted the claim.
During the course of the review, if additional documentation is needed, a new ADR will be issued which can be sent to an alternate address. This can be provided to the CERT customer service representative (CSR) by calling 888-779-7477.
Documentation can be submitted as follows and instructions are included in the ADR:
- Postal Mail
- Fax
- Electronic Submission of Medical Documentation (esMD)
- CD (encrypted)
- Email attachment (encrypted)
Documentation checklists are provided for your convenience on the CERT resources center as well as the CERT C3HUB website.