During a CERT review, you may receive a Medicare record request by mail. The letter will ask for information related to a claim you submitted, such as medical records or certificates of medical necessity, so the CERT reviewer can verify that billing was proper.
- Respond promptly to a CERT request for information by submitting the requested supporting documentation within the time frame outlined in the request. If you miss the deadline, the CERT program registers an "error" against TrailBlazer and you on the assumption you never rendered the services.
- Send the specific records listed on the bar-coded cover sheet to support the services of each claim identified on the medical records/documentation pull list.
- Photocopy each record. Make sure all copies are complete, legible, and include both sides of each page.
- Place the bar-coded cover sheet in front of the medical records/documentation being submitted for review.
- Also note:
- Forwarding specifically requested records to the CERT contractor does not violate privacy provisions under the Health Insurance Portability and Accountability Act (HIPAA).
- You do not need to obtain additional beneficiary authorization to forward medical records to the CERT contractor.
- You cannot be reimbursed through the CERT program for the cost of duplication or mailing.
For additional information, visit the CERT Web site at or call (301) 957-2380 or (888) 779-7477.
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