CERT program
What is CERT
CMS established the Comprehensive Error Rate Testing (CERT) program to monitor and report the accuracy of Medicare fee-for-service (FFS) payments. The CERT program measures the error rate for claims submitted to Medicare contractors. First Coast uses CERT data to identify areas of focus for medical review and provider outreach and education efforts. The improper payment rate is released annually in the Department of Health and Human Services (HHS) Agency Financial Report (AFR).
What's the status of my CERT review
This tool provides information for sampled claims where a decision has been made by the CERT RC. The file will indicate current status of the review upon entry of the control identification number (CID). Data is refreshed weekly.
For more information about the status of the CERT review, you can also visit the CERT C3HUB website external link and select "Claim Status Search" from the menu.
Appealing a CERT error
If the CERT RC claim review results in an error and you disagree or have additional documentation to support the billed service, you should submit an appeal to First Coast within 120 days from the date on the most recent remittance advice.
For step-by-step instructions for completing an appeal request, visit the Appeals page.