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Comprehensive Error Rate Testing (CERT) Program

CGS created the Jurisdiction C DME MAC CERT Claim Identifier (CID) Tool to help you locate your CERT review decision. All you need is the 7-digit Claim ID (CID) number from your CERT documentation request letter.

The Centers for Medicare & Medicaid Services established the Comprehensive Error Rate Testing (CERT) program to monitor and report the accuracy of Medicare fee-for-service (FFS) payments. The CERT program measures the error rate for claims submitted to Medicare contractors. One of the major outcomes of the CERT program is an annual paid claims error rate (percentage of dollars paid incorrectly). CGS uses information about top error categories to develop materials for providers, to help increase the accuracy of submitted claims.

The CERT C3HUB web siteExternal Website is designed to provide Medicare providers, suppliers, and contractors with information about the CERT program and to facilitate coordination, collaboration, and communications between all stakeholders. Visit the CERT C3HUB web siteExternal Website for the latest announcements, information on submitting documentation, initial and subsequent request schedules, contact information, sample letters, and FAQs.

Learn more about the CERT program through these resources:

Reduced Sample Size Starting with Reporting Year 2025

CMS will permanently reduce the CERT program sample size starting with reporting year (RY) 2025. The sample size for improper payment measurement review will decrease from 50,000 to 37,500 claims annually.

If the CERT Review Contractor completes the RY 2025 review but removes your claim from the sample, they'll send you a letter.

Your Medicare Administrative Contractor will:

  • Adjust the claim if required to reflect the correct codes and payment.
  • Pay or collect if needed.

Appealing a CERT Error

A redetermination (1st level appeal) may be requested if you feel a CERT error was called incorrectly. Suppliers have the same appeal rights for CERT initiated denials as they do for denials initiated through CGS. When requesting a redetermination, be specific about why you feel the denial was incorrect. Send additional documentation and medical records that may be available to support the medical need for the item(s) denied. For more information about the appeals process, refer to the Appeals section of our website.

To find out more about what documentation may have been missing or why the error was called please access the JC DME MAC CERT Claim Identifier Tool.

Additional CERT Resources


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