EDI Claim Selection

EDI Claim Selection For CERT Review Basic Principles

EDI Claim Selection supposes review the bar coded sheet, included with the CERT letter, to determine what documentation is being requested. Keep a copy of the CERT letter, including the bar coded sheet, on file within your agency. Gather all documentation requested in the letter, and any additional documentation that supports the coverage and medical necessity of all services billed for the dates of service indicated on the request. Make sure all copies are complete, legible, and contain both sides of each page. Place the bar coded cover sheet in front of the documentation.

You may submit this documentation in any of the following ways:

  • Via postal mail to:
    CERT Documentation Center
    1510 East Parham Road
    Henrico, VA 23228
  • Via fax to: 1.804.261.8100
    1. Use the barcoded cover sheet as the only coversheet.
    2. Do not add your own cover sheet—this slows down the receipt and identification process
    3. Send a separate fax transmission for each individual claim.
  • Via Electronic Submission of Medical Documentation (esMD):
    1. Include a CID# or Claim number and the barcoded cover sheet in your file transmission.
  • Via CD:
    1. The images should be encrypted per HIPAA security rules.
    2. If encrypted, the password and CID# must be provided via email to CERTMail@admedcorp.com or via fax to 1.804.264.9764.
    3. Must contain only images in TIFF or PDF format.
  • Via Email Attachment:
    1. The email attachment(s) should be encrypted per HIPAA security rules.
    2. If encrypted, the password and CID# must be provided via phone to 1.888.779.7477 or via fax to 1.804.264.9764.
    3. Must contain only attachments in TIFF or PDF format.

Initial Request Schedule:

  • Day 0: Send letter 1 requesting documentation. The provider has 45 days from this letter to furnish the requested documentation.
  • Day 25: Telephone contact to follow-up on request and/or offer assistance.
  • Day 30: Send letter 2. The provider has 15 days left to complete the request
  • Day 40: Telephone contact to follow-up on request and/or offer assistance.
  • Day 45: Send letter 3. (Response is due)
  • Day 55: Telephone contact to follow-up on request and/or offer assistance (Response is overdue)
  • Day 60: Send letter 4. (Response is overdue)
  • Day 76: Claim is counted as non-response error and is subject to overpayment recovery by the Medicare Administrative Contractor (MAC).

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