What is it? A program developed by CMS to randomly audit claims monthly to determine if they processed correctly. Contractors then use this information to determine the cause of errors working to resolve them.
Why does it matter? To protect the Medicare trust fund and determine error rates nationally and regionally. The error rate assists CMS in determining a contractor’s future so it is important for Highmark Medicare Services to educate our customers about proper billing techniques.
Who is involved? You. A request for medical records from AdvanceMed alerts you that one of your claims has been selected as part of the monthly random sample. If you have a specific contact that you would like to receive requests please make this known by visiting: https://www.certcdc.com/certportal/pages/
How does it work? A letter will be sent to your office requesting the medical documentation. You need to comply in a timely manner with the request. No response or sending in only part of the requested documentation will result in a CERT denial and a refund of monies previously paid.
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| CERT Medical Records Requests | CERT Articles/FAQ | |
Medical Records are requested from the CERT contractor. Information regarding these requests are linked below. |
Highmark Medicare Services often writes articles and FAQ on CERT. Click on the links below for CERT topics of interest. |
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| Common CERT Errors | CERT Education | |
Each quarter Highmark Medicare Services will provide you with information regarding the error types that are causing provider issues. Providers can use this information to avoid the same error. Common CERT Errors 2009 July - September April - June January - March Common CERT Errors 2008 July - September |
Highmark Medicare Services provides various educational programs on CERT errors. Join us in person or take an online course. You make the choice that fits your schedule. |
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| CERT References | ||
| Additional information can be found on the CERT through the links below. | ||
| CERT Reports | ||
CMS issues CERT reports bi-annually. The links below will link you directly to the CMS reports. |
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