CommercialAdministrativeMedium impact
Cotiviti collaboration aims to prevent payment errors and improve the reimbursement process
UPMC Health Plan·Reimbursement
We identified it
Jun 20, 2026
Summary
UPMC Health Plan has partnered with Cotiviti Inc. to conduct post-payment reviews of medical claims, including retrospective accuracy reviews and clinical claim validation reviews. Providers may receive letters requesting medical records for selected claims and must respond within specified timeframes.
Action Required
Immediately: Billing team should establish process to respond to Cotiviti Clinical Claim Validation review letters. When received, gather requested medical records for identified claims and respond within outlined timeframes. Contact UPMC Health Plan Provider Services at 1-866-918-1595 with questions (available Monday-Friday, 8 a.m. to 6 p.m. EST). Ensure coding accuracy as claims are subject to retrospective accuracy reviews.