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Published Date: 2025-06-24

Cotiviti Claims Pattern Review (CPR) Appeals Process

As a friendly reminder, Highmark Wholecare now utilizes Cotiviti Claims Pattern Review (CPR) for our claims processing. CPR uses real-time analytics to enable expert review of claims, with the ability to pause processing for validation prior to payment, improving overall payment accuracy and efficiency.

Providers must utilize one of the three options listed below to send in Cotiviti CPR Appeals:

Direct upload to the Secure Portal. Simply click on the “Submit Records” button and enter your password: high90CCVC.
Secure faxing to 800-409-0499.
Mailing the records directly to Cotiviti. Please mark the envelope “Confidential” and send to:

C/O Cotiviti-6150
10701 S Riverfront Pkwy,
Box 12017
South Jordan, Utah 84095

Providers have the right to submit any claim for review they feel was denied or paid incorrectly. The Cotiviti CPR Appeals process has changed to streamline the process for providers.

Cotiviti is a separate company that administers pre-pay claim editing, retrospective data mining activities, readmissions, and chart reviews for Highmark Wholecare.