Comprehensive Error Rate Testing Teaching and Instruction for Providers Letters
Published 04/08/2022
When the Comprehensive Error Rate Testing (CERT) contractor has decided to partially or fully deny a claim based on coverage or billing issues, providers will receive an individual CERT Teaching and Instruction for Providers (TIP) letter for each claim denial.
The CERT TIP Letter was created to:
- Enhance the provider's knowledge regarding the CERT program
- Provide education specific to the denial reason
- Provide suggestions to prevent similar denials from occurring in the future
- Provide information regarding the appeal process
The CERT TIP Letter will include the following:
- Comprehensive article regarding the CERT program
- Provider's appeal rights for the CERT process
- Pertinent website and/or reference information regarding the CERT program and coverage issues
If you have any questions regarding the CERT TIP letter or CERT program in general, please call the Provider Contact Center (PCC) at 855–696–0705 for the JM Contract.
Note: TIP letters are to be used for educational purposes only. This letter does not serve as a denial notification for appeals purposes.