Medical Review Contractors

The Centers for Medicare & Medicaid Services (CMS) utilizes a number of contractors to conduct medical review of claims and documentation, including:

  • Medicare Administrative Contractors (MACs), including CGS
  • Comprehensive Error Rate Testing (CERT) contractors
  • Recovery Auditors (RAs)
  • Zone Program Integrity Contractors (ZPICs)
  • Supplemental Medical Review Contractor (SMRC)

Information about the CERT program and contractors is available on the CGS Part B CERT Web page. Other information related to CGS medical review and medical review by other contractors is available on this web page. You may also find the following resources helpful:

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