Faxing Additional Documentation for CERT Denials - JA DME

For CERT denials, the supplier has two options presented to them on the fax:

1. Fax all newly obtained documentation to the CERT Documentation Office fax number (804-261-8100); or
2. Complete the Medicare DME Redetermination Request Form. Fax the form and all documentation to support the claim (i.e., newly obtained documentation AND previously submitted documentation) to the Noridian JA Redeterminations fax number. Note: Include the CERT Identification Number (CID) on the submitted Redetermination form to assist with processing of the appeal. Check "YES" for overpayment appeal request. Check the "CERT" box for the overpayment appeal type.

For option one listed above, the supplier only sends in the missing documentation to the CERT Documentation Office for consideration of payment by the CERT Review Contractor. If this option is chosen by the supplier, the supplier is only notified of a CERT overturned claim. If the claim is found to remain denied, the supplier is not notified.

For option two listed above, the supplier files an appeal with Noridian following the same process as a claim denial. The supplier sends in all documentation to support the billed claim. The supplier is notified of the outcome of the appeal by the remittance advice for a fully favorable decision or a letter if found partially favorable or denied. If the claim remains denied, the supplier has appeal rights to go onto the next level of appeals.

The supplier should never send documentation back to the CERT fax number they received the denial comments on. This fax number is not for appealed claims and information sent here is in error. To have your claim reviewed appropriately, ensure the above steps are followed and the documentation is sent to the correct location.