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)."

Recent Announcements

Bridging Smiles and Systems: Collaborative Care for Children with Chronic Conditions

Please join us for a live, CME-accredited and CEU-accredited webinar on May 13 from noon to 1p.m., that will explore the critical connection between oral health and pediatric chronic conditions such as diabetes, asthma, congenital heart disease, and ADHD.
Feb. 2026Education/Webinars

February 2026 UPMC for You and UPMC Community HealthChoices formulary update

Pulmicort Flexhaler has a new distributor, Rubicon Holding. National Drug Codes (NDCs) for Pulmicort Flexhaler from Rubicon Holding are not included in the Medicaid Drug Rebate program and are not covered under the Medicaid Prescription Drug Program. Pulmicort Flexhaler NDCs from the previous manufacturer, H2 Pharma, have been discontinued but may be billed/dispensed until supplies are exhausted.
Feb. 2026Pharmacy Updates

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