09/30/2011
Comprehensive Error Rate Testing (CERT) Teaching and Instruction for Providers (TIP) Letters from Medical Review
When the Comprehensive Error Rate Testing (CERT) contractor has made a decision to partially or fully deny a claim based on coverage or billing issues, providers will receive an individual CERT Teaching and Instruction for Providers (TIP) letter for each claim denial.
The CERT TIP Letter was created to:
- Enhance the provider's knowledge regarding the CERT program
- Provide education specific to the denial reason
- Provide suggestions to prevent similar denials from occurring in the future
- Provide information regarding the appeal process
The CERT TIP Letter will include the following:
- Comprehensive article regarding the CERT program
- Provider's appeal rights for the CERT process
- Pertinent Web site and/or reference information regarding the CERT program and coverage issues
The Medical Review Department published an article about the CERT program on the CGS Web site. This article titled The ABCs of the Comprehensive Error Rate Testing (CERT) Program and How to Respond to CERT Requests includes a checklist for different lines of business to use when responding to CERT Requests.
If you have any questions regarding the CERT TIP letter or CERT program in general, please contact Provider Contact Center at (866) 590-6703
NOTE – TIP letters are to be used for educational purposes only. This letter does not serve as a denial notification for appeals purposes.
