J5 MAC Part A Providers serving beneficiaries in Iowa, Kansas, Missouri and Nebraska

Comprehensive Error Rate Testing (CERT) FAQs

  1. What is the purpose of the Medicare Comprehensive Error Rate Testing (CERT) program?
  2. Who are the CERT Contractor(s)?
  3. What happens if I am selected for a CERT review?
  4. Do I need to have the beneficiary's authorization to release information for a CERT review?
  5. What do the letters from the CERT look like?
  6. What is the CID that is mentioned in the letter?
  7. How long do I have to respond to a documentation request?
  8. How do I get the results of my CERT claim review?


  1. What is the purpose of the Medicare Comprehensive Error Rate Testing (CERT) program?
    CERT is a program integrity activity that the Centers for Medicare & Medicaid Services (CMS) established to monitor the accuracy of the Medicare Fee-For-Service program.


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  2. Who are the CERT Contractor(s)?
    Company Responsible for Contact Information
    Livanta - CERT Documentation Contractor Obtaining the CERT submitted documentation from providers 9090 Junction Drive, Suite 9
    Annapolis Junction, MD 20701
    Phone: (888) 779-7477 or (301) 957-2380
    Fax: (240)-568-6222
    AdvanceMed - CERT Review Contractor Reviewing the CERT submitted documentation forwarded by Livanta 1530 E. Parham Road
    Richmond, Virginia 23228
    Phone: (804) 264-1778


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  3. What happens if I am selected for a CERT review?
    You will receive a request letter that includes all of the information you need to process the request. Requests for records from the CERT Contractor do not pose any HIPAA vulnerabilities and must receive prompt attention. Respond to all requests for information from within the timeframe allowed.


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  4. Do I need to have the beneficiary's authorization to release information for a CERT review?
    No. Medicare patients have already given authorization to release necessary medical information in order to process claims. Therefore, Medicare contractors do not need to obtain a patient's authorization to release medical information to AdvanceMed or CDC.


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  5. What do the letters from the CERT look like?
    Sample documentation request letters external link are found on the CERT Documentation Contractor (CDC) Provider Portal website. If a response is not received within 30 days of the initial letter, the CDC will send a second letter. A third letter will be sent out 60 days after the initial letter, and the final letter is sent 75 days after the initial letter.


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  6. What is the CID that is mentioned in the letter?
    The Claim Identification Number for identifying CERT documentation requests


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  7. How long do I have to respond to a documentation request?
    The CERT contractor must receive all requested documentation within 75 days of the initial request. However, it is recommended that responses are sent as soon as possible to avoid delays and further requests. Invalid or insufficient documentation will result in a denial or reduction of the claim payment.


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  8. How do I get the results of my CERT claim review?
    The CERT contractor is not responsible for providing claim review results. If you have a question about your specific CERT review findings, please e-mail WPS Medicare at Medicare.CERT.Part.A@wpsic.com. Be sure to include "CERT Review Results" in the subject line and the Claim Identification Number (CID), and include your full name, address, telephone number, and Provider Transaction Access Number or Provider Identification Number (if available) in the body of the e-mail. This will assure a prompt reply to your request.

    When e-mailing WPS Medicare, please do not include sensitive information. If your question pertains to a specific claim, include the Internal Control Number, not your patient's Medicare Health Insurance Claim Number.


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Page Last Updated: Monday, 04-Jan-2010 15:18:09 CST