US · guidance
CMS Pub. 100-08, ch. 12, § 12.4.2
Providing Review Information to the CERT Review Contractor
The MAC shall indicate, in the resolution file, if the claim lines were subject to manual
medical review or not.
Upon request from CMS or the CERT review contractor, the MAC shall provide all
applicable materials used by the MAC to make a payment decision on a CERT sampled
claim. Normally, additional material is required on less than 10 percent of sampled
claims. Each MAC shall provide the requested information to the CERT review
contractor within 10 business days of the request.
History
(Rev. 852; Issued: 12-21-18; Effective: 1-24-19; Implementation: 1-24-19)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
3a94105d5ac5cd21e191e9846f2f417164b927bac0fad19546778f5edbda977f
The link goes to the issuing authority’s own document — the one we read to produce this record. Where a source publishes whole titles rather than sections, your browser may need a moment to jump to the provision.
Unofficial copy of government-published law, reproduced from official sources with full provenance. Not an official publication; verify against official sources before relying on it in a filing. Records in the 'guidance' corpus, and only that corpus, are sub-regulatory (interpretive guidelines, survey procedures) and are not binding law. Validity bounds follow each jurisdiction's declared temporalBasis.