CERT Review Decisions When you send medical record requests to CERT operations for review, the CERT Documentation Contractor (CDC), located in Annapolis, Md., images and stores the information you provide. The information is then forwarded to the CRC (CERT Review Contractor) nurses at AdvanceMed of Richmond, Va., for claim determination.
Twice a month, Palmetto GBA, as the Affiliated Contractor (AC) is notified of all CERT review decisions. Palmetto GBA only notifies providers when a CERT review disagreed with the AC payment of the claim. Generally, reviews are completed within 3 ½ months of receipt of the medical record.
Providers can contact the CDC to check if a claim has completed the review and this information can be given to providers, however, CDC customer services personnel cannot communicate the results of a CERT review to a provider.
All appeals for a CERT medical review should be filed with PalmettoGBA. The appeals process for CERT denials is the same as any other denial made by the Palmetto GBA Appeals Department.
Other helpful CERT tips - All documentation should contain a legible beneficiary name, first and last, the name should exactly match the beneficiary's Medicare card as that is the name that we have in our system.
- All documentation should contain a legible provider signature; if the provider signature is not legible the name should be printed below the signature.
- All documentation should contain the date that the service was rendered.
- It is the responsibility of the billing provider to obtain documentation from other entities to support the services if the billing provider does not keep the documentation on file.