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January 30, 2024

Avoid CERT No Documentation Errors

CGS has identified an increase in the number of Comprehensive Error Rate Testing (CERT) reviews that receive No Documentation errors. The CERT Review Contractor assigns the No Documentation error category (error code 16) to claims when the provider or supplier:

  • Fails to respond to repeated requests for medical records
  • Responds that they don't have the requested documentation

Examples of provider responses that may result in a No Documentation error include, but are not limited to:

  • No record of this patient in our system.
  • No records for date of service requested.
  • Patient was seen at a different facility, not in our office.
  • Barcoded cover sheet not returned with documentation.

To avoid a CERT No Documentation error and recoupment of your claim payment:

  • Carefully review the claim information and barcoded cover sheet.
  • The documents listed on the barcoded cover sheet are typical of documents needed to support Medicare payment of the claim. Please provide ALL pertinent medical records/documentation and any additional documentation to support the specified claim.
  • The provider that billed the claim is responsible for maintaining all documentation necessary to support the services billed on the claim. In some cases, you may need to obtain records from a different provider (e.g., referring/ordering provider or rendering provider/facility) and/or for dates prior to and/or after the billed date of service.
  • When you send documentation, always include the barcoded cover sheet as the first page. This allows the CERT Documentation Contractor to identify the correct beneficiary/date(s) of service to which the documentation applies.

For more tips and resources, please select CERT in the left navigation menu or visit the CERT C3HUBExternal Website website.

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