CERT Documentation Contractor - Update
The Centers for Medicare & Medicaid Services (CMS) are modifying the process for CERT medical records requests. Although this transition is expected to be seamless, you may notice a few changes if you have previously had claims reviewed as part of a CERT sample.
Previously, AdvanceMed, the CERT Review Contractor (CRC) in Richmond, Virginia, has been responsible for both requesting and reviewing medical records for CERT sampled claims. However, the task of requesting the medical records is being transitioned to a new CERT Documentation Contractor (CDC) located in Annapolis Junction, Maryland.
The timeframes for complying with the documentation requests will remain the same. However, the new contractor will be taking additional steps in an effort to improve overall communication and improve response times.
Prior to sending out the initial request for documentation, the CDC will attempt to make a telephone contact to your office in order to obtain a Point of Contact (POC). If this contact is successful, the CDC will fax (preferred method) or mail the medical record request directly to the POC. This contact information is retained by the CDC to insure that future CERT correspondence is directed to the appropriate staff and reaches your facility in a timely manner.
Please note that until this transition is complete, you may receive letters from both AdvanceMed and the CRC. We ask that you please respond to these requests by sending the documentation to the address or fax number indicated on the letter corresponding to the specific claim.
If you have been notified that you were part of a CERT sample, but the record requests did not reach your practice, or were delayed or misrouted, you may change the address of where your CERT requests are mailed, or add a fax number or POC for your facility. Please fax this information to WPS at (608) 301-2625, ATTN: CERT Address Change. Please include your Medicare provider number and a contact name and telephone number so that we can contact you to confirm that your request was received.
Providing updated contact information and timely responses to CERT requests for documentation directly contributes to the reduction of the CERT error rate. For more information on the CERT program please visit our Website by clicking here, or submit your questions using our 'Contact Us' page.
