Letter and Contact Information

The CERT Review Contractor issues an Additional Documentation Request (ADR) to obtain medical records for each claim line sampled for CERT review. We strive to ensure that all contact with providers is as minimal and efficient as possible to accomplish the tasks with the least amount of effort or burden on the providers. For Initial ADRs, the CERT Review Contractor follows this schedule:

Initial Request Schedule

While conducting medical review of the documentation received, the medical review specialist may identify the need for additional information. A new additional documentation request will be issued to obtain the specific item of missing documentation. The response time for this second request is shorter. The CERT Review Contractor follows this schedule:

Subsequent Request Schedule

Address Updates

Comprehensive Error Rate Testing (CERT) Program New Processes

Documentation Requests

The above processes are based on each individual CID; providers will need to contact the CERT office as mentioned above for each sampled claim.

For information on updating addresses with PECOS, please see MLN Matters® Article SE1617 for additional information.

Chain Address Program

Providers who have at least ten (10) PTAN/OSCAR numbers who would like to elect a single point of contact (POC) can participate in the “chain address” program recently implemented by CERT. This program is as follows:

Group Calls

In order to reduce provider burden, when multiple calls are due to the same phone number, the CERT RC groups the calls so that a single contact can be made with the provider (providers) associated with that phone number to discuss all outstanding requests.

*****IMPORTANT NOTE: This change is ONLY in regards to the CERT program