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
Pause in Prior Authorization Policies
On April 1, 2025, we announced that UPMC Health Plan would start requiring prior authorization for certain services. Please note that we are delaying or changing the implementation of prior authorization for some of these services, as described below.May 2025Important Notices
May is Mental Health Awareness Month
“Turn Awareness into Action”Mental Health America founded Mental Health Month in 1949, and since that time, every May has been a time to unite millions of people to promote awareness, provide vital resources, and advocate for everyones mental well-being. 1 in 5 people will experience a mental health condition in any given year¹. Mental health affects us all, and its critical that we move beyond awareness to take meaningful steps for our well-being and that of our community.May 2025Important Notices
Special notice: Important policy changes
Effective June 1, 2025, UPMC Health Plan will be implementing policy changes that will require providers to obtain prior authorizations for services listed in the following policies. For more information, please visit upmchp.us/policiesandprocedures.May 2025Important Notices