Your Corrective Action Plans Support Compliance

Highmark Wholecare’s Financial Investigations and Provider Reviews (FIPR) team conducts audits regarding fraud waste and abuse (FWA). An audit that identifies errors will require corrective actions, including a Corrective Action Plan (CAP) to address and resolve the deficiencies. Providers are responsible for correcting areas of noncompliance. An effective CAP will:

• Specify steps to remediate the underlying problem, including identifying time frames of implementation and staff members who are responsible for changes
• Improve processes so that outcomes are more effective and efficient
• Include methods to monitor the effectiveness of the changes

Providers are expected to submit a CAP when requested within 30 days. Subsequent FWA audits may be performed to measure CAP adherence.

Resources:

• Corrective Action Plan (CAP) Guidelines
• Medicaid Provider Manual
• Medicare Provider Manual

Questions:

Contact the Special Investigations Unit (SIU) at SIU@highmark.com or call the FWA hotline at 844-718-6400.