Steps to Take if You Get a CERT Documentation Request

Published 08/15/2025

To be Medicare-compliant and ensure a timely response to Comprehensive Error Rate Testing (CERT) review contractor (RC) documentation requests, please remember the following.

  1. Review the CERT RC letter request for these important sections:
    • Action: Medical Records Required — This is the list of records to support claim payment
    • When: “Date” — This is the deadline to provide medical records to the CERT RC
       
  2. Prepare records for submission
    • Locate and assemble all records listed in the CERT RC’s letter
    • Identify any missing records and take action to obtain them
    • Make copies for submission and keep the originals
       
  3. Submit the information by the deadline
    • Follow instructions in the CERT RC’s letter
    • Place the CERT RC’s bar-coded cover sheet in front of your records

Follow up by accessing the CERT RC C3HUB. The Claim Status Search feature will confirm if the CERT RC got your records. Failure to submit the requested documentation to the CERT RC may result in a recoupment of payment.

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