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The claims value in dispute must meet the threshold for obtaining an administrative law judge (ALJ) hearing and a judicial review in federal district court. This is called the “amount in controversy.” The amount in controversy is recalculat…
This edition includes information for critical access hospitals, skilled nursing facilities, inpatient psychiatric facilities, and more.
Review this information for details on the 2026 enrollment application fee.
Before you request a redetermination on a denied claim, review these tips to avert delays in payment and save some valuable time.
Read the fourth quarter edition of the CERT Insider's Guide to learn more about the CERT program and the improper payment rate calculation.
View these submission guidelines for ASC prior authorization requests.
Read this article for information about the CERT comparative analysis reports.
The PAR fax/mail coversheet for ASCs is now available for Florida ASCs participating in the ASC PA demonstration. ASCs in Florida can submit PARs beginning on January 5, 2026, for dates of service (DOS) on or after January 19, 2026.
Prior authorization (PA) for the ASC prior authorization demonstration is voluntary. However, if a provider elects to bypass PA, applicable ASC claims will be subject to prepayment medical review.
Part A and B providers can easily submit their Prior Authorization Request (PAR) forms in SPOT for certain hospital outpatient department services.