Revisions to Chapter 12 (The Comprehensive Error Rate Testing (CERT) Program) and Exhibit 46 in the Exhibits Chapter of Publication (Pub.) 100-08 (Medicare Program Integrity Manual)
The purpose of this Change Request (CR) is to revise sub-section 12.4.1.E (Claims with Multiple Versions), section 2.5 (Handling Overpayments and Underpayments Resulting from the CERT Findings), section 12.10.1 (Fraud Investigations), section 12.10.2 (No Response to Additional Documentation Request (ADR)), and section 12.10.3 (Insufficient Response to ADRs) in Chapter 12 (The Comprehensive Error Rate Testing (CERT) Program) of Pub 100-08. This CR also revises sub-exhibit 46.4 (CERT Unified Post-payment ADR Sample Letter) in the Exhibits Chapter of Pub. 100-08.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: July 30, 2026
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