When medical records are requested, the billing provider is responsible to obtain sufficient documentation to support the medical necessity of the service(s) billed. If the documentation is insufficient to support medical necessity, the claim may be denied.* National Government Services expects that the patient's medical records will reflect the need for the medical care provided.
The supporting documentation includes any third party documentation, such as the treating physician’s documentation, that may be available only through the physician’s office.
When submitting records for review to National Government Services or the CERT contractor, please ensure:
For questions regarding documentation needed:
Contact National Government Services (See “Provider Contact Center" in "Contact Us”)
When submitting records for review to the CERT contractor, please complete the following steps:
CERT Documentation Center
CID #
1510 East Parham Rd.
Henrico, VA 23228
Option to Mail Medical Records on CD
Providers submitting documentation via CD should send the password to CERTmail@nciinc.com; use the CID number in the subject line of your email (no PHI).
Note: There is no need for the provider to encrypt the password email. Following this procedure will ensure there is no delay in processing the documentation.
Note: Where physician signature is required - Signature key or attestation statement is needed if signature is not legible. This should include physician typed or printed name and signature. If orders are on an electronic ordering system—include protocol describing - physician enters the electronic system with unique ID and password.
* Section 1833(e) of the Social Security Act precludes payment to any provider of services unless “there has been furnished such information as may be necessary in order to determine the amounts due such provider.”
Suggested documentation to be obtained (not all inclusive and depends on the services billed) is as follows: