Responding to CERT Documentation Requests

Why do I have to respond to these requests? They aren’t from Palmetto GBA. 
Responding to a medical records request from any Medicare contractor is a requirement from the Centers for Medicare and Medicaid Services (CMS). The Comprehensive Error Rate Testing (CERT) contractor is a separate entity from your MAC. Their primary role in protecting the Medicare Trust Fund is to ensure that you are billing correctly and that we are paying correctly. Postpay review of medical records is conducted to determine this. Not responding to your request will result in your claim denying and recoupment of overpayment.

What do I need to send?
Submitting the correct documentation is another component to ensuring your claim is not denied. Have you have received an initial request for records and are unsure as to what is required? CERT provides documentation request listings based on provider/billing type on their website that providers are encouraged to use. If you are printing these pages, it is important to check the website periodically to confirm you have the most recent version.

While conducting medical review of the documentation received, the need for additional information may be identified. A new additional “subsequent” documentation request will be sent by CERT to obtain the specific missing documentation. When responding to a subsequent additional documentation request, your barcoded scan cover sheet will provide you a list of what CERT’s missing to complete the review of your records. This request will also list what they have already received. Response time for these requests are shorter than that of initial request.

Where do I send the requested records? 
CERT preferred method of transmission is fax. Regardless of submission method, your barcoded scan cover sheet should always be included and on the top of each record submitted. All the following are acceptable methods for submitting your records:

• Fax to (804) 261–8100
  • Use the barcoded cover sheet as the only coversheet
  • Do not add your own cover sheet — this slows down the receipt and identification process
  • Send a separate fax transmission for each individual claim
     
• U.S. Mail
  CERT Documentation Center
  8701 Park Central Drive, Suite 400-A
  Richmond, VA 23227
   
• Electronic Submission of Medical Documentation (esMD)
  • Include the CID # or claim number and the barcoded cover sheet in your file transmission
  • Information on esMD can be found at www.cms.gov/esMD
  • For questions about esMD please contact: esMDBusinessOwners@cms.hhs.gov
     
• CD
  • The images should be encrypted per HIPAA security rules
  • If encrypted, the password and CID # must be provided via email to CertMail@empower.ai or via fax to (804) 261–8100
  • Must contain only images in TIFF or PDF format
     
• Email Attachment
  • The email attachment(s) should be encrypted per HIPAA security rules
  • If encrypted, the password and CID# must be provided via phone to 888–779–7477 or via fax to (804) 261–8100
  • Must contain only attachments in TIFF or PDF format

You may also submit your documentation to Palmetto GBA's medical records department. However, this will cause a delay in CERT receiving your documentation. 

• Fax to (803) 699–2432 (Attn: CERT Coordinator)
  • Use ony the barcoded cover sheet 
  • Do not add your own cover sheet as this slows down the receipt and identification process
  • Send a separate fax transmission for each individual claim