Program_Memos / 2002 / AB-02-178

Why This Topic Matters

It helps readers understand how CERT error findings are handled administratively and what reporting artifacts and review steps are involved. This is important for organizations that manage Medicare claim review, reconciliation, and postpayment processes.

Article Sections

1. Background

   Introduces the CERT-related feedback workflow and the role of contractor communication in disputed claim findings.

2. Purpose

   Describes the memorandum’s scope and the overall process for submitting CERT findings to the contractor resolution workflow.

3. Resolution Guidelines

   Summarizes the panel review structure, submitted materials, timing, final reporting, overpayment handling, and contractor follow-up procedures.

4. Quality Assurance Function

   Covers the annual quality assurance review activity for CERT program claims and the distribution of QA findings.

5. ATTACHMENT 1: Data Items Included on CERT Reports and Screens

   Lists the data elements used on the CERT reports and screens, including report-specific fields and completion responsibility.