Claim Specific CERT Errors – November 2017

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.

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) or Cahaba’s CERT Coordinator (Ashley Carroll-205-220-1698) 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.

If submitting documentation by CD, providers should send the password to: with the subject of the e-mail to include the CID number. There is no need to encrypt the e-mail.

All CERT inquiries and medical records are to be sent to the following:

CERT Documentation Center
1510 East Parham Road
Henrico, VA 23228
Fax: 804 261-8100
Customer Service: 443 663-2699
Toll Free: 888 779-7477

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

Please contact Ashley Carroll regarding detailed information for individual CERT results:

  • 1-205-220-1698

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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