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CGS Administrators, LLC

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CERT Tips – Make Your Efforts Count

Did you know that over 50% of the additional documentation and documentation submitted late cannot be used to make the final decision on your audit?

The CERT Contractor and CGS make every effort possible to obtain documentation from the supplier/provider to support the claim which is being audited before an error is called and money recouped. A timely response to documentation requests avoids delays in CERT decisions on your claim and ultimately, if the claim is found in error, recoupment of payments.

Below are some of the top reasons your documentation may not be reviewed by the CERT Contractor:

Exact documentation previously submitted is being re-submitted.

Notes sent by the supplier stating "No Documentation Found"

Orders requested by CERT are not submitted

Notes submitted by the supplier stating that the patient was not seen by the physician writing the order.

Notes submitted by the supplier stating the patient cannot be found in their system.

Documentation submitted contains no clinical documentation

Documentation submitted for review does not include the dates surrounding/or the date of service in question.

Supplier returns only the barcoded sheet or a fax coversheet with no documentation

Documentation submitted is illegible

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