CERT Reduces Initial Time Frame for Initial Documentation Request to 60-Day Time Frame

Beginning Jan. 1, 2014, providers will have 60 days to submit medical documentation in response to initial documentation requests for claims selected by the Comprehensive Error Rate Testing (CERT) Program for review. Currently, providers have 75 days to respond to initial documentation requests. If no documentation is received by the 60th day, the claim will be considered a no documentation error and recoupment will be pursued. Suppliers who do not respond to the initial request will receive two additional letters in 15 day increments. If suppliers have not responded by the 60th day the supplier will receive a denial due to no response to the request for documentation.

Suppliers must respond with the requested documentation within 30 days from the date indicated on the initial request letter. The CERT contractor will send the CERT documentation request letters to the payee address on file with the National Supplier Clearinghouse (NSC). Providers should also ensure their contact information is correct and up to date in the NSC database.