CERT Articles

Learn more about common CERT errors and answers to common CERT questions.

Title Description
Avoiding CERT denials for Proof of Delivery View list of documentation to avoid denials for billing Proof of Delivery
CERT Errors - CPAPs and Accessories View listing of top CERT error comments in efforts to assist suppliers by preventing or eliminating errors, particularly for face masks and nasal application devices.
CERT Errors - Knee Orthoses View coverage and billing information for Knee Orthoses
CERT Errors - Nebulizers and Drugs View listing of top CERT error comments in efforts to assist suppliers in how to prevent or eliminate these errors, particularly for inhalation drugs.
Claims Selected for Review Following PAR An affirmed Prior Authorization Request (PAR) does not exclude the subsequent Power Mobility Device (PMD) claims from CERT reviews in the future.
Comprehensive Error Rate Testing Program: Reduced Sample Size and Discarded Claims The Comprehensive Error Rate Testing (CERT) Program has permanently reduced the sample size, starting with reporting year (RY) 2025. As a result of this reduction, some RY 2025 sampled claims may be removed or discarded.
Faxing Additional Documentation for CERT Denials Review the two options suppliers have when a CERT denial is received.
Ordering Physician and CMS-1500 Claim Form Suppliers are strongly encouraged to check their documentation from referring physicians or other healthcare practitioners and ensure that the information listed in Item 17 and Item17b on the CMS-1500 form for the referring provider matches the information on the order for any item of DMEPOS.
Provider/Supplier Address Updates with CERT The CERT DC is no longer able to update supplier's contact information on file for CERT claims. Providers must make updates within PECOS.
Provider/Supplier Mailing Addresses and Point of Contact for CERT Requests Effective August 14, 2018, NCI mails all Initial CERT Additional Documentation Request (ADR) letters to Correspondence Address on file with Provider Enrollment, Chain and Ownership System (PECOS) for provider/supplier that billed/submitted claim.

 

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