Comprehensive Error Rate Testing (CERT)
Use the Jurisdiction J15 CERT Claim Identifier (CID) Tool to obtain completed CERT review results.
The Centers for Medicare & Medicaid Services (CMS) estimates the Medicare Fee-for-Service (FFS) program improper payment rate through the Comprehensive Error Rate Testing (CERT) program. Each year, the CERT program reviews a statistically valid stratified random sample of Medicare FFS claims to determine if they were paid properly under Medicare coverage, coding, and payment rules.
The CERT C3HUB web site 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 site for CERT Review Results, 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:
- CERT C3HUB web site
- CMS Comprehensive Error Rate Testing Information, Data and Reports
- CERT A/B MAC Outreach & Education Task Force Learning Network
- Health & Human Services Financial Reports, Search Comprehensive Error Rate Testing to Obtain National CERT Error Results
- Top Provider Questions: Comprehensive Error Rate Testing (CERT) Program
- CERT Claim Identifier Tool
Appealing a CERT Error
You may request a redetermination (1st level appeal) if you feel you received an incorrect CERT denial. Providers 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 J15 CERT Claim Identifier Tool.
Contact Information
CERT Documentation Center
8701 Park Central Drive Suite 400-A
Richmond, VA 23227
Customer Service: 888.779.7477
Fax: 804.261.8100
Email: certprovider@empower.ai
CGS CERT Coordinator
615.664.5961 (fax)
J15CERTCID@cgsadmin.com
Updated: 04.17.23