National Government Services has experienced an increasing number of CERT errors due to “no documentation” received. The provider either does not respond to the CERT documentation request letter(s), or the provider does respond with a notice indicating the medical records are located elsewhere.
CERT Letters: The CERT contractor sends all initial letters to the address on file with the PECOS for the provider that billed the claim. After the initial letter, CERT sends a minimum of three additional letters to the provider.
CERT Phone Calls: CERT will also make several phones calls requesting documentation to support the claim billed.
CERT Response Stating Documentation is Located Elsewhere: It is the billing provider’s responsibility to obtain the information from the hospital, nursing home, referring provider, etc. If the documentation is at another site, either forward the request to that site or contact the CERT contactor at 888-779-7477 and provide the other sites contact information.
Revised 1/21/2021