CERT Record Requests, Responses, and Review Results

The Comprehensive Error Rate Testing (CERT) contractors continue to see common issues on a national level related to CERT medical record requests, responses, and provider inquiries regarding claim review results. WPS Medicare is providing the following information on these topics to assist providers in avoiding these issues.

Address or Point of Contact Updates for CERT Requests

Providers sometimes report that the CERT medical record request is not sent to the appropriate contact person at their facility. To view or update your address and contact information for CERT medical record requests, visit the CERT Provider website(external link). If updating information, you must enter Contractor ID 05102 for the states of Iowa, Kansas, Missouri, and Nebraska.

Medical Record Responses

We continue to see a significant number of errors for insufficient documentation because critical components of the medical records are omitted from the response to the CERT request. We recommend providers review all documentation prior to submittal to CERT for the necessary handwritten or electronic provider signatures, signed and dated physician orders (if applicable), and any additional documentation to support the medical necessity of the service(s) billed. If your practice utilizes an electronic health record, it is crucial to verify all portions of the medical record (e.g., physician orders, physician signature, test results, etc.) are visible prior to printing and submitting various components to Medicare.
Below are more tips from the CERT Documentation contractor.

  • It is not necessary to copy the bar coded cover sheet for every page. One bar coded sheet inserted at the front of your documents for each claim is sufficient.
  • Voluminous pages of medical records can be mailed on Compact Discs (CDs). The CERT contractor will accept CDs in TIFF or PDF format with no subfolders or internal viewing software.
  • Documentation is often received that is illegible because the copy is too light or too dark, or consists of a shaded computer screen print out. Please ensure all pages are legible prior to faxing documentation. If you cannot obtain a better copy please mail the records to CERT.
  • The CERT contractor and WPS Medicare do not reimburse providers/suppliers or copy centers for the cost of medical record copying or mailing. Requests for payment should not be sent in response to Medicare record requests.

Requests for CERT Review Results

Inquiries regarding CERT contractor reviews should be e-mailed to WPS Medicare at medicareadmin@wpsic.com. Type "CERT Review Results" in the subject line and include your full name, Medicare provider transaction number (PTAN), and CERT CID number (if available) in the body of the e-mail. Please omit any protected health information (PHI), such as a beneficiary's Health Insurance Claim Number (HICN). Note: Please contact WPS Medicare Customer Service with inquires regarding claims denied or reduced as a result of reviews conducted by WPS Medical Review.

Page Last Updated: Monday, 12-Dec-2011 15:58:05 CST