Fast facts: CERT vaccine and roster billed claims

The Comprehensive Error Rate Testing (CERT) review contractor (RC) randomly selects a statistically valid sample of Medicare fee-for-service claims and reviews those claims for payment errors. The CERT program considers any payment that should not have been made or that was paid at an incorrect amount (including both overpayments and underpayments) to be an improper payment. 

CMS has issued updated guidance to the CERT RC regarding the medical review of vaccine and roster bill claims. These changes apply to all influenza, pneumonia, hepatitis B, and COVID-19 vaccination claims.

Effective with CERT report year 27 (RY27):

• Vaccine and roster bill claims will no longer be automatically approved.

• The CERT RC will issue additional documentation requests (ADRs) for these claims.

• All claims will undergo full medical review, consistent with applicable statutes, regulations, and national and local coverage determination policies.

Additionally, the CERT RC began reviewing previously auto approved claims. ADRs for these claims will began issuance on Monday, February 23, 2026.

Please ensure that all relevant supporting documentation is readily available for this expanded review activity.