COMPREHENSIVE ERROR RATE TESTING REVIEW CONTRACTOR

Select a stratified random selection of claims from the Medicare FFS claims universeRequest medical records from the billing and ordering providers to support the claims billedReceive 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 reviewConduct MR on claims selected for CERT and other accuracy reviews, as specified by CMSCommunicate MR results to the MACs, providers, and other stakeholdersCollect and transmit data to the CERT Statistical Contractor (CERT SC) for purposes of calculating improper payment ratesMaintain various websites for internal and external stakeholdersEstablish mechanisms to manage, monitor and mitigate unexpected fluctuations in the Contractor’s workloadPerform additional tasks to support the mandate of the CERT program, as directed by CMS and the Statement of Work