01/28/2015
Comprehensive Error Rate Testing (CERT) Notification of Errors
When the CERT contractor makes a decision to partially or fully deny a claim based on coverage or billing issues, providers will receive an individual CERT letter for each claim denial.
The CERT Letter will:
- Enhance the provider's knowledge regarding the CERT program
- Provide education specific to the denial reason; and
- Provide information regarding the appeal process
The CERT Letter will include the following:
- Provider's appeal rights for the CERT process
- Pertinent website and/or reference information regarding the error
Providers may gain a better understanding of the CERT Program by reviewing an article titled “The ABCs of the Comprehensive Error Rate Testing (CERT) Program and How to Respond to CERT Requests” that is available on the CGS website. The article details:
- The CERT Program
- The CERT contractors and their roles
- How to respond to a CERT request for documentation
If you have any questions regarding the CERT program please contact our CERT Coordinator at: 615.782.4591.