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.
If you have any questions, please contact UPMC Health Plan’s Provider Services team at 1-866-918-1595. The team is available Monday through Friday, 8 a.m. to 6 p.m. (EST)."

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