Cotiviti collaboration aims to prevent payment errors and improve the reimbursement process
Sep. 2022Important Notices
"This month, UPMC Health Plan began collaborating with Cotiviti Inc. after its acquisition of Health Management Services’ payment integrity solutions. The collaboration is for the following periodic post-payment reviews of paid medical claims, which are similar to reviews previously conducted by Health Management Services:
- Retrospective Accuracy (RA) reviews. Cotiviti uses data from paid claims to conduct these reviews that help ensure appropriate coding. These reviews do not require additional documentation from the provider.
- Clinical Claim Validation (CCV) reviews. In these cases, Cotiviti reviews medical records to ensure appropriate billing. If a claim is identified for a CCV review, the provider will receive a letter that:
- Identifies the selected the claim(s).
- Requests detailed information on the selected the claim(s), including a required copy of the medical records, if UPMC Health Plan has not already received these medical records. Outlines the response guidelines and time frames.
Recent Announcements
CME Webinar: American Foundation for Suicide Prevention’s ‘Talk Saves Lives’ Program
Please join us on Tuesday, April 28, from noon to 1 p.m. for “Talk Saves Lives: An Introduction to Suicide Prevention.” This live, CME-accredited webinar is the American Foundation for Suicide Prevention’s flagship suicide prevention education program. It covers the scope of this leading cause of death, warning signs and risk factors for suicide, and strategies to prevent it.Feb. 2026Education/Webinars
Training Webinar: Conversio Health COPD Management Program
Please join us for a live training webinar by UPMC Health Plan that will provide an overview of a comprehensive COPD management program from Conversio Health.Jan. 2026Education/Webinars
Provider Directory Updates and Required Attestation
As you know, UPMC Health Plan requires all providers to verify their provider directory information at least every 90 days (quarterly).Jan. 2026Important Notices