Other Review Entities
Suppliers can receive claim review requests from multiple Medicare contractors. In addition to Medical Review (MR) prepay complex reviews, suppliers billing Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) for Medicare commonly encounter a variety of other review entities requesting supporting documentation and performing reviews for CMS. Review entities may include the below.
Comprehensive Error Rate Testing (CERT) - View various CERT articles, AdvanceMed 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 - View RA program details, contact information, types of reviews and the options available when receiving an RA decision.
Supplemental Medical Review Contractor (SMRC) - Access current and completed projects, the discussion/education period, documentation requests and hot SMRC topics.
Unified Program Integrity Contractor (UPIC) MW - View UPIC functions and non-functions.
Zone Program Integrity Contractor (ZPIC) - View ZPIC functions and non-functions.
Last Updated Apr 25, 2017