September 28, 2017
Responding to CERT Requests
When a claim is selected for Comprehensive Error Rate Testing (CERT) review, the CERT review contractor will send a letter to the provider requesting medical documentation. The letter includes various options for you to submit this documentation to the CERT review contractor. Please review the following options:
- Via Postal Mail to:
CERT Documentation Center
1510 East Parham Road
Henrico, Virginia 23228
- Via Fax to: 1.804.261.8100
- Use the barcoded cover sheet as the only coversheet.
- Do not add your own cover sheet – this slows down the receipt and identification process
- Send a separate fax transmission for each individual claim.
- Via Electronic Submission of Medical Documentation (esMD):
- Include a CID# or Claim number and the barcoded cover sheet in your file transmission.
- Information on esMD can be found on the esMD Overview
page on the CMS website.
- Via Encrypted CD:
- Must contain only images in TIFF or PDF format.
- The images must be encrypted using a CMS approved, FIPS 140-2 encryption method such as SecureZIP.
- Adobe encryption does not comply with this standard.
- WinZip must be specifically configured for compliance.
- No self-extracting or .exe files will be accepted.
- DO NOT include the password in the same package as the CD. Prior to sending the CD, forward the CID# and password via email to CERTmail@nciinc.com or via fax to 1.804.261.8100.
- Via Encrypted Email Attachment:
- Must contain only attachments in TIFF or PDF format.
- The attachments must be encrypted using a CMS approved, FIPS 140-2 encryption method such as SecureZIP.
- Adobe encryption does not comply with this standard.
- WinZip must be specifically configured for compliance.
- No self-extracting or .exe files will be accepted.
- The allowable file size is 15 megabytes (MB) per attachment, for a maximum file size of 30 MB per email.
- If the file size exceeds 30 MB per email, an alternative documentation submission method (i.e., postal mail, encrypted CD, fax, or esMD) must be used.
- DO NOT include the attachment password in the same email and DO NOT send the attachment password via a separate email. The password and CID# must be provided via phone to 1.888.779.7477 or via fax to 1.804.261.8100.