Providing Review Information to the CERT Review Contractor

12.4.2 – Providing Review Information to the CERT Review Contractor (Rev. 852; Issued: 12-21-18; Effective: 1-24-19; Implementation: 1-24-19) 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.