CERT


Once you have logged into eServices, locate the eReview tab. If you cannot view this tab, you may not have the necessary permissions. Contact your provider administrator on the account to request access. From the eReview tab, select the eAudit sub-tab. This section currently features CERT contractor claim review and status information that is updated monthly.

Select CERT Claim Review Status from the Audit Type dropdown menu on the eAudit screen, it will automatically populate with a summary table of your CERT audit data by error code category.

  • The claim data table will list the type of error by claim and claims pending review by the CERT contractor
  • The claim data details table will allow users to see the claim line details for that audit error code category noted on the claim data table. There is also a definition of the line error code. Each of the items in the claim data details table can be expanded for extra details.

Last Reviewed: 10/22/2021

The CERT program is comprised of two contractors. Each contractor has separate responsibilities. Examples of those duties are listed below:

1. The CERT Review Contractor (CERT RC) — NCI Information Systems, Inc.

  • Sample claims
  • Requests, receives and reviews all medical records
  • Images medical records
  • Performs quality control of those records
  • Provider customer service
  • Education support
  • Compiles data
  • Maintains the CERT C3Hub

2. The CERT Statistical Contractor (CERT SC) — The Lewin Group, Inc.

  • Calculates improper payment rates
  • Designs sampling strategy
  • Maintains Live Data dashboard

Please visit CMS Comprehensive Error Rate Testing (CERT) for more information concerning these contractors.

Last Reviewed: 10/22/2021





CERT Articles