Responding to Documentation Requests

Respond promptly to each line of the claim being reviewed!

Providers are responsible for responding to all documentation requests from the CDC within the specified timeframe. Your response is required even if records for the sampled beneficiary dates of service cannot be provided. It is your responsibility to obtain additional supporting documentation from a third party (hospital, nursing home, doctor’s office, etc.) if needed.

Submission of medical records for CERT review does not violate the HIPAA Privacy Rule. Physicians, providers and suppliers do not have to obtain authorization from the beneficiary to release information to the CDC.

Documentation requests from the CDC will include a Claims pull list and a Bar-code sheet. The request letter will have detailed instructions for completing the bar-code sheet, mailing the record, and contact information. The letter will also specify a Claim Identification Number (CID) to be used when referring to the claim. Both the bar-code sheet and CID should be attached to the front of the medical records when submitting to the CDC; otherwise, the record may not be able to be matched to the correct claim, resulting in a claim denial.

NGS, Inc, has also developed a checklist to assist providers in gathering documentation when responding to a request by the CDC.

When photocopying the claim, verify that all pages are complete and legible. You should fax the records with the attached bar-code sheet to the CDC at (240) 568-6222. If your fax machine stamps your fax number on the top of your sent pages, then you will receive a faxed receipt from the CDC for your records transmission.

Records may also be mailed, at your expense, to:

The CDC will not issue receipts for records received by mail. It is advisable to mail all medical records via registered or certified mail, or by a courier that provides delivery confirmation.