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Fast facts: Responding to CERT additional documentation requests
Last Modified: 6/30/2025
Location: FL, PR, USVI
Business: Part A, Part B
The Comprehensive Error Rate Testing (CERT) program measures the error rate of fee-for-service (FFS) payments that didn’t meet Medicare requirements; it does not indicate fraud. Response to requests for documentation by the CERT Review Contractor (RC) is required.
Initial additional documentation requests (ADRs) for medical records are requested from the billing provider or supplier for each claim selected for CERT review. The provider has 45 days from this letter to furnish the requested documentation.
• Three initial request ADRs are sent via mail on the following schedule:
• Day 0: Initial letter 1 requesting documentation is sent.
• Day 30: Initial letter 2 sent; the provider has 15 days left to complete the request.
• Day 45: Initial letter 3 sent; the response is now due.
• Day 60: The claim is now subject to overpayment recovery by the MAC as a non-response error.
While conducting medical review of the documentation received, the medical review specialist may identify the need for additional information. A subsequent ADR with a shorter response time will be issued to obtain the specific item of missing documentation.
• Two Subsequent Request ADRs are sent on the following schedule:
• Day 1: Letter 1 is sent, followed by a phone call from the CERT RC.
• Day 10: Letter 2 is sent.
• Day 16: Claim back in review process with available records.
Documentation can be submitted in any of the following ways:
• Via postal mail to:
CERT Documentation Center
8701 Park Central Drive, Suite 400-A
Richmond, Virginia 23227
• Via secure fax to the CERT RC: 804-261-8100
• Use the barcoded cover sheet as the only coversheet.
• Do not add your own cover sheet - this slows down the receipt and identification process.
• Send a separate fax transmission for each individual claim.
• Via Electronic Submission of Medical Documentation (esMD):
• Include a claim identifier (CID) or claim number and the barcoded cover sheet in your file transmission.
• Via CD (must contain only images in TIFF or PDF format):
• The images should be encrypted per HIPAA security rules.
• If encrypted, the password and CID# must be provided via email to CERTMail@empower.ai or via fax to 804-261-8100.
• Via Email Attachment (must contain only attachments in TIFF or PDF format):
• The email attachment(s) should be encrypted per HIPAA security rules.
• If encrypted, the password and CID# must be provided via phone to 888-779-7477 or via fax to 804-261-8100.
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.