No Documentation Received
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.
- Providers should periodically verify if the address information in PECOS is correct and update, if necessary. Provide the staff, which sorts the mail at the addresses listed in PECOS, a copy of the CERT request letter and envelope. Sample Request Letters and an envelope are displayed on the CERT C3HUB provider website. This will help the staff route the CERT requests to the appropriate area and may prevent the no documentation error.
- Providers having at least ten PTAN/OSCAR numbers who would like to elect a single point of contact can participate in the “chain address” program implemented by CERT. For further information, access the Letter and Contact Information on the CERT C3HUB provider website. The provider can participate in the program by calling the CERT office at 888-779-7477 with a list of PTAN/OSCAR numbers and the designated point of contact information.
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.
Related Content
- Centers for Medicare & Medicaid Services Internet-Only Manual Publication 100-04, Medicare Claims Processing Manual, Chapter 1, Section 110 (Categories of Health Insurance Records to be Retained)
- Learn About PECOS
Revised 1/21/2021