Submitting Medical Records
How do I Appeal a CERT Denial?
If you have received notification that a claim has been denied by the CERT due to non-submission of records, or insufficient documentation, and you have obtained the requested records, you should send those records to the CDC. They will determine if their review can be completed with the additional records, which may result in a revision of the error rate and a reversal of the claim denial, when appropriate.
Records can be faxed to the CERT Docuntation Contractor at (240) 568-6222.
Please be sure to include the CERTs original request letter since it contains the bar code or if the request letter is not available, write the CERT Claim ID number on each page of the records.
All other denials should be appealed through WPS-Medicare's Claims Appeals Department through the normal appeals process.
Page Last Updated: Friday, 15-Aug-2008 13:22:11 CDT
