CMS RAC Provider Resources

How to

Use the Provider PortalLogging in & navigation


Submit DocumentationMethods & formatting requirements


Submit a Discussion RequestFillable Discussion Request Form


Update Your Contact Information - Individual ProviderAddress, fax, email, contact of record


Update Your Contact Information - Multi-ProviderAddress, fax, email, contact of record

This spreadsheet can be opened using Microsoft Excel or Open Office.  For a free download of Open Office Click Here


Knowledge Base

Approved Issues
All CMS-approved reviews by type & state


RAC Frequently Asked QuestionsThorough answers to quick questions


PIP Frequently Asked QuestionsFor Periodic Interim Payment providers


Additional Information

CMS Manuals
Council for Medicare Integrity
Medicare Coverage Database
Medicare FAQ
Recovery Audit Program Overview

Cotiviti.com Accessibility and Compliance with Section 508

Download Adobe Acrobat Reader here.

Updates and News

 


Change to Provider’s Discussion Period

There are a number of changes to the Recovery Audit program effective January 1, 2016.  One of those changes is the length of time a Provider has to submit a Discussion Request following a RAC review. Two important alerts:

(1)  The Provider has the option to submit a Discussion Request within 30 days from the date of the Review Results Letter for a Complex review, and within 30 days from the date of the Portal notification for an Automated review.  During this period we will not submit an adjustment to your Payer.  We encourage all providers to utilize the Discussion process if there is additional information/documentation that you believe would change the outcome of our review.

To do so, please utilize our updated Discussion Request Form on this page above.  For your convenience, the form can be completed electronically and directions for submission are on the form itself.  Please note that the Recovery Auditors are not required to entertain discussion requests submitted greater than 30 days after the date of Review Results Letter for Complex reviews or 30 days after the date of the Portal notification for Automated reviews.

(2)  We will display Automated review findings on the Provider Portal as soon as they become available.  (Previously they were not displayed until the Payer validated they were going to make the subsequent adjustment.)  The Status Effective Date will start the 30-day period described above.

For additional information on all of the changes to the Recovery Audit program, please click here to view the CMS publication.


Change to Facility Medical Record Request Limits

The new Medical Record Request Limits for facilities are effective with any Additional Documentation Request (ADR) letters dated January 1, 2016 or later. (ADR’s issued prior to January 1, 2016 adhere to the prior CMS guidelines.)   There are significant changes to the prior methodology for calculating these limits. One of the most significant changes is that CMS, not the Recovery Auditors, will calculate the limits and the limits are calculated by NPI – not by campus.  Limits are also subject to change based on NPI-specific audit results.  For additional information including other changes to the Recovery Audit program effective January 1, 2016, please click here to view the CMS publication.


Connolly iHealth Technologies Changes Name to Cotiviti

For more information about the availability of auxiliary aids and services, please visit: https://www.medicare.gov/about-us/accessibility/accessibility-aids.html