Late Documentation Received by the CERT Review Contractor

12.11 – Late Documentation Received by the CERT Review Contractor (Rev. 13678; Issued: 03-12-26; Effective: 04-13-26; Implementation: 04-13-26) This section applies to Medicare Administrative Contractors (MACs) and Comprehensive Error Rate Testing (CERT) as indicated. The MACs may submit any additional documentation received from the provider or supplier to the CERT review contractor for consideration as late documentation. If the CERT review contractor receives late documentation before the review decision is posted on the C3HUB, the CERT review contractor reviews the late documentation and scores the claim appropriately. If the CERT review contractor receives late documentation after the review decision has been posted on the C3HUB, the CERT review contractor checks to see if the MAC has entered an appeal in the C3HUB. If the MAC has entered an appeal for the CERT-initiated denial in the C3HUB, the CERT review contractor does not review the late documentation. If the MAC has not entered an appeal for the CERT-initiated denial in the C3HUB, the CERT review contractor reviews the late documentation and scores the claim appropriately. If the late documentation is received before the cutoff date to receive late documentation for the report (in time to complete review before the cutoff dates for the report) it is included in that year’s improper payment rate calculation. The MAC shall notify the provider of the change in denial reason. These cases are included in the feedback section of the C3HUB.