Explanation of Differences in Contractors
- Affiliated Contractors (ACs): The insurance companies which are responsible for reviewing claims and making payments to hospitals, doctors, and durable medical suppliers.
- CERT Review Contractor (CRC): Nurse reviewers who review Medicare claims which are randomly selected to insure that the claims have been properly paid. In addition, the CRC produces a public report in November and a report for the ACs in May each year. The reports are a compilation of statistical information about the Medicare claim fee-for-service program.
- CERT Documentation Contractor (CDC): The CDC is responsible for the request and receipt of medical record documentation from providers (hospitals, doctors, and durable medical equipment suppliers) to support the claims being reviewed by the CRC. The CDC also operates a call center, scans all medical record documentation received, verifies that the correct documentation has been sent by providers, and has a problem resolution department that handles problem cases.

