Claim Specific CERT Errors – February 2018

JJ  MAC B (Alabama, Georgia, Tennessee)

The Comprehensive Error Rate Testing (CERT) Program was implemented by the Centers for Medicare & Medicaid Services (CMS) to monitor the accuracy of claims processing by Medicare contractors, like Cahaba. Contractors are then notified by CERT of the errors and findings.

We would like to remind providers that should you receive an Additional Documentation Request (ADR) such as a request for records to support services that are involved in a CERT review, the appropriate documentation should be submitted to support the services billed, including but not limited to progress note(s) to match the DOS billed, lab results, operative reports, diagnostic tests, physician orders, etc.  Medicare requires a legible identifier for services provided/ordered.  The method used shall be hand written or an electronic signature (stamp signatures are not acceptable) to sign an order or other medical record documentation for medical review purposes. Please include the appropriate CERT Barcoded Cover Sheet with all submitted documentation.

All initial documentation request letters will have a due date 45 days after the date the first letter was printed.  The fourth letter includes a subject line:  RESPONSE OVERDUE.   Providers have 75 days to submit documentation before a no response error is assigned.

For address changes, providers will need to update PECOS (Provider Enrollment, Chain and Ownership System) so the address is consistent throughout CMS.

All FIRST Additional Documentation Request (ADR) letters for CERT are sent to the address on file with Cahaba for the provider/supplier that billed/submitted the claim.

All SUBSEQUENT ADR letters can be sent to a specific correspondence address.  This can be provided to the CERT Customer Service Representative (CSR) by calling 888-779-7477.

Chain Address Program

Providers who have at least ten (10) PTAN 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:

  • Call the CERT office (888-779-7477) with a list of PTAN numbers and the designated point of contact information.
  • To assure you supply the information to CERT within the 45 days, CERT will email/call the point of contact with a list of outstanding CID numbers.
  • NOTE: Due to the FIRST letter being sent to the provider address on file, these may be requests the point of contact has not yet received.
  • When requested, the CERT CSR will forward a copy of the letters not yet received.

Group Calls

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

Providers may submit documentation in any of the following ways.

  • Via Postal Mail to:

CERT Documentation Center
1510 East Parham Road
Henrico, Virginia 23228

  • Via Fax to: 804-261-8100 or 443-663-2698

Use the barcoded cover sheet as the only coversheet.

Do not add your own cover sheet—this slows down the receipt and identification process

Send a separate fax transmission for each individual claim.

  • Via Electronic Submission of Medical Documentation (esMD):

Include a CID# or Claim number and the barcoded cover sheet in your file transmission.

Information on esMD can be found at

  • Via CD:

The images should be encrypted per HIPAA security rules.

If encrypted, the password and CID# must be provided via email to or via fax to 804-264-9764.

Must contain only images in TIFF or PDF format.

  • Via Email Attachment:

The email attachment(s) should be encrypted per HIPAA security rules.

If encrypted, the password and CID# must be provided via phone to 888-779-7477 or via fax to 804-264-9764.

Must contain only attachments in TIFF or PDF format.

A Provider Documentation Request Listings is available on the CERT Provider Website

Listings are provided in alphabetical order and are based on provider/billing type.  Listings will be updated as changes are approved.  Please check the website periodically for updates.

Providers may appeal unfavorable decisions with additional supporting documentation. For detailed information regarding the Appeals Process, refer to the following link:

Please contact the Cahaba Provider Contact Center for individual questions concerning outcomes of CERT reviews and/or payment adjustments:

  • Alabama, Georgia and Tennessee Providers – 1-877-567-7271

The following summary provides examples of Cahaba’s errors identified by CERT. We encourage all providers to review this listing to educate you on common errors.  This information will be updated periodically.  The intent in providing this information is to prompt you to conduct an internal analysis of Medicare billing and reduce future denials by Medicare.


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