Forms - JE Part B
Other Review Contractor Forms
Universal
- Documentation Requirement Checklists
- Electronic Order Signature Process [PDF]
- Review Contractor Correspondence Tracking [Excel]
- Signature Attestation Statement [PDF]
Comprehensive Error Rate Testing (CERT)
- Provider CERT POC [PDF]
Recovery Auditor (RAC)
- There are no specific RAC related forms, see Universal forms
Supplemental Medical Review Contractor (SMRC)
- There are no specific SMRC related forms, see Universal forms
Form Assistance
PDF File Downloading Technical Assistance
Due to varying Internet Browsers and versions of Adobe, users may receive the error message, "Adobe PDF Document. There is a problem with Adobe Acrobat/Reader. If it is running, exit, and try again. (0:104)"
If this occurs, close the error message and use the browser "refresh" button, or press the F5 key, to reload the PDF.
If this error continues, it may be necessary to update your version of Adobe Reader, or to disable the option to display PDFs in your browser. See Display PDF in browser help webpage.
Interactive Form Tips
Select "Highlight fields" and/or "Highlight required fields" to ensure all form fields are completed.
To view field instructions (including CMS supplied instructions, when provided), hover over desired field.
Blank and completed forms may be saved to a user's computer. Right-click PDF hyperlink and select "Save as."
Electronic completion minimizes possibility of illegible handwritten forms.
