Cotiviti Claims Pattern Review (CPR) Appeals Process

Highmark Wholecare utilizes Cotiviti Claims Pattern Review (CPR) to enhance the accuracy, integrity, and timeliness of our claims processing. CPR has enabled efficient Payment Policy Management and allows for the review of claims using real-time analytics, including the ability to pause claims processing which lets Cotiviti CPR experts review for proper validation prior to payment.

Where to Send Appeals for CPR

Providers have the right to submit for review any claim they feel was denied or paid incorrectly. The Cotiviti CPR Appeals process is changing to streamline the process for providers. Providers will now have three options for submitting Cotiviti CPR Appeals:

1. Direct upload to the Secure Portal. Simply click on the “Submit Records” button and enter your password: high90CCVC.
2. Secure faxing to 800-409-0499.
3. 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

NOTE: These changes will be reflected in the Highmark Wholecare Medicaid and Medicare Provider Manuals in the near future.