CERT Documentation Contractor Transition Medical Record Request and Receipt Functions
The CERT program calculates the error rate for Medicare claims submitted to Carriers, Durable Medical Equipment Regional Carriers (DMERCs), and Fiscal Intermediaries (FIs). The Centers for Medicare and Medicaid Services (CMS) receives in excess of 2 billion claims per year of which CERT randomly selects a statistical sample for review to ensure the claims were paid properly. Beginning July 1, 2005 the CERT Program will begin using two contractors to accomplish this work - the CERT Documentation Contractor (CDC) and the CERT Review Contractor (CRC).
Failure to receive requested medical records remains one of the highest causes of Medicare errors in the CERT program. The CDC will be responsible for requesting and receiving medical record documentation in support of the provider's claim. Their call center operation attempts to make telephone contact with the provider's office to explain the program and to explain that the request is in accordance with the Health Insurance Portability and Accountability Act (HIPAA) followed by a faxed or mailed medical request letter to the provider's office. The request letters are specifically tailored to the medical functions and services performed by the provider. The CDC call center operates between the hours of 8:00 am to 8:00 pm Eastern Standard Time, and their phone number is (301) 957-2380. The call center customer service representatives are available to take incoming phone calls and answer your questions. The CDC will forward the requested documentation to the CRC. The CRC, staffed by specially trained nurses and physicians, will review the claim to ensure it was paid correctly.
Requests for medical records received prior to July 1, 2005 may be faxed to (804) 264-3268. Requests received after June 30, 2005 may be faxed to (240) 568-6222. Fax is the preferred method of delivery.
Voluminous pages of medical record documentation may be sent via mail to:
Prior to July 1st:
CERT Operations Center
Attn: Disposition Department – Distribution
1530 E. Parham Road
Richmond,VA 23228
After June 30th:
CERT Documentation Office
9090 Junction Drive, Suite 9
Annapolis Junction,Maryland 20701
Every effort is made to secure the medical record documentation from providers in a timely manner. Failure to provide the necessary documentation will result in a denial of the provider's claim.

