Inactive

Select a stratified random selection of claims from the Medicare FFS claims universe Request medical records from the billing and ordering providers to support the claims billed Receive and process me... Select a stratified random selection of claims from the Medicare FFS claims universe Request medical records from the billing and ordering providers to support the claims billed Receive and process medical records for purposes of conducting medical review (MR) Provide customer service support to the Medicare Administrative Contractors (MACs) and providers who have claims selected for review Conduct MR on claims selected for CERT and other accuracy reviews, as specified by CMS Communicate MR results to the MACs, providers, and other stakeholders Collect and transmit data to the CERT Statistical Contractor (CERT SC) for purposes of calculating improper payment rates Maintain various websites for internal and external stakeholders Establish mechanisms to manage, monitor and mitigate unexpected fluctuations in the Contractor’s workload Perform additional tasks to support the mandate of the CERT program, as directed by CMS and the Statement of Work (SOW)