Other Review Contractors

Suppliers can receive claim review requests from multiple Medicare contractors. In addition to Medical Review (MR) medical record reviews, suppliers billing Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) for Medicare commonly encounter a variety of other review entities requesting additional documentation requests (ADR) and performing reviews for CMS. Suppliers that do not agree with the outcome of these reviews can appeal these review entities decisions. Review entities may include:

Comprehensive Error Rate Testing (CERT) - View various CERT articles, Empower AI, Inc. information, documentation charts, the review process, communication types and/or submit a CERT related email.

Office of Inspector General (OIG) - View OIG information and access the OIG website.

Recovery Auditor (RA) - View RA information, access the RA website and the options available when receiving an RA decision.

Supplemental Medical Review Contractor (SMRC) - View SMRC information and access the SMRC website for current projects, completed projects, the discussion/education period, documentation requests and hot topics.

Unified Program Integrity Contractor (UPIC) - View UPIC information, access the Midwest and Western UPIC websites and view UPIC functions and non-functions.

Last Updated Jun 18 , 2024