Riverbend

Tips for Documentation

What Documentation to Submit:

Each charge on the claim should be supported with the following:

• Documentation to support the medical necessity
• Documentation that the procedure/service was performed
• Documentation that reflects the correct name and date of service identified on the claim

Please Note:

• Each record request not responded to will be denied in total
• Each record request not responded to will initiate a mandated OIG referral
• Each incomplete record submitted will be denied in part or in total
• If there is no supporting documentation that the procedure/service was performed, there will be no reimbursement

Each record request from CERT requires a provider response EVEN IF the provider does not have the record. If no response is received by CERT, the claim will be denied

Each request from CERT will include a Claims Pull List and a Bar-Code sheet. They are necessary for identifying and submitting the record. The request will have detailed instructions for completing the bar-code sheet, mailing the record, and it will list contact information for questions