If you have any questions regarding Provider Self-Audits, you can contact Highmark Wholecare’s Special Investigation Unit (SIU) at FIPR-ProviderSelfAudits@highmark.com.

Information to Submit for Self-Identified Overpayment:

When submitting information for an identified overpayment, please include the following:

• Provider information (i.e. Name, NPI, TIN, Contact Information, etc.)
• Self-audit/overpayment information
• Period of claims
  • For claims more than two years old, please provide a check.
  • For claims less than two years old, retraction of claims is preferred.
• List of affected claims and/or extrapolation calculation used to determine overpayment amount.
• Other information (as required)

Please be aware if a listing of claims is not provided, Highmark Wholecare cannot guarantee that the claims will not be audited again, for the same reason. Deposit of a provider check or retraction of the requested claims does not constitute complete agreement to the submitted self-audit results or overpayment amount. The Financial Investigations and Provider Review (FIPR) Department may contact the provider to discuss self-audit results as necessary.

TRENDSubmit: Provider Self-Reporting Process

Providers can electronically submit overpayments via TRENDSubmit. This secure, online process allows providers to be notified of claim retractions in real-time and eliminates the lengthy manual paper process. The TRENDSubmit team provides user training resources and ongoing support.

Please see below for more information on TRENDSubmit. In addition, providers can contact Jennifer Baron (jbaron@trendhealthpartners.com) in order to initiate TRENDSubmit access.

• TRENDSubmit Flyer