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CGS Administrators, LLC

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Medical Review Pre-/post- Payment Contractor Information

Prepayment and postpayment claim review targeted to those services with the highest improper payments is one strategy that CGS Medical Review utilizes to prevent identified program vulnerabilities. However, Medical Review is not the only CGS department or only Medicare contractor that may request supplier records either for a pre-payment or post-payment claim review. Therefore it is essential that suppliers read any correspondence related to additional documentation requests thoroughly and carefully follow the instructions for submitting the requested information. The table below lists the contractors and the types of claims they review in Jurisdiction C:

Contractor Name Pre-payment Post-payment
CGS – DME MAC Claims x  
CGS – DME MAC Medical Review x x
CGS – DME MAC Appeals (Redeterminations)   x
CERT Documentation Contractor   x
Safeguard Services, LLC – Unified Program Integrity Contractor (UPIC) – Southeastern and NortheasternExternal Website x x
Qlarant – Unified Program Integrity Contractor (UPIC) – Western and SouthwesternExternal Website x x
CoventBridge Group – Unified Program Integrity Contractor (UPIC) – MidwesternExternal Website x x
Performant Recovery, Inc. – Recovery Audit Contractor (RAC)External Website x x
Supplemental Medical Review Contractor (SMRC)External Website x x

More information about Additional Development Requests (ADRs)

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