CMS RAC Region 3

CMS RAC

Your NPI number is now required to log into the Provider Portal.

With the provider portal, you can:

  • Upload discussions and correspondence
  • Download, view and print RAC letters
  • Upload medical records
  • Check your claim review status 24/7
  • Update contact information
  • Export data
New to working with Cotiviti?

Click here to visit our welcome page.

Whether you're new to RAC or to working with Cotiviti, we have resources to help you. 

CONTRACT UPDATES:


May 1, 2024
 
Region 2 Close Out
 
As of April 30, 2024, the Recovery Audit Contractor (RAC) Region 2 administrative period has ended.  Cotiviti Region 2 audit claim questions should be directed to the Medicare Administrative Contractor (MAC).  Current Region 2 audits are performed by Performant Recovery, Inc. RAC Region 2 includes the following Medicare Administrative Contractor jurisdictions: J5, J6, and JH.

May 23, 2023
 
Medical Reviews Post-Public Health Emergency (PHE)
 
“The Centers for Medicare & Medicaid Services (CMS) is required to protect the Medicare Trust Fund against inappropriate payments which pose a risk to the Trust Fund. Therefore, subsequent to the Biden Administration’s termination of the Public Health Emergency (PHE), we are resuming normal Medicare Fee-for-Service (FFS) medical review activities. Please visit the https://www.cms.gov/research-statistics-data-and-systems/monitoring-programs/medicare-ffs-compliance-programs/overview to stay up-to-date on Medicare FFS Compliance Programs, such as the RAC Program, and considerations surrounding the COVID-19 PHE.”

 
March 28, 2023

Region 2 Transition

On March 24, 2022, CMS awarded Performant Recovery, Inc., the new Recovery Audit Contractor (RAC) Region 2 contract. RAC Region 2 includes the following Medicare Administrative Contractor (MAC) jurisdictions: J5, J6, and JH.

Cotiviti, LLC, the RAC previously responsible for reviews in Region 2, remains under contract with CMS to support the RAC Program from an administrative and appeals perspective in this region. Please contact Cotiviti in regards to reviews conducted by Cotiviti. All notification of improper payments, including review results letters (complex reviews), informational letters (automated reviews) and no findings letters (complex reviews) were completed by Cotiviti, in Region 2, on or before Friday, September 16, 2022.

CMS anticipates Performant will begin reviews in the Spring (2023). RAC Region 2 providers can rely on the review completion date specified in the review results letter, as well as the RAC’s name on the letter, to identify which contractor to reach for inquiries. If Performant receives inquiries in regards to reviews conducted by Cotiviti, Performant customer service will inform providers to reach out to Cotiviti and vice versa.

Region 2 Contact Information:

Cotiviti, LLC
www.Cotiviti.com/RAC
RACinfo@Cotiviti.com
1-866-360-2507

Performant Recovery, Inc.
https://performantrac.com/providerportal.aspx
info@Performantrac.com
1-866-201-0580


April 14, 2022

Additional Documentation Limits for Medicare providers (except suppliers and physicians)

Effective May 1, 2022, the Centers for Medicare & Medicaid Services (CMS) has modified the additional documentation request (ADR) limits for the Medicare Fee-for-Service Recovery Audit Contractor (RAC) program providers. Additional information can be found on the CMS RAC Program Resources website.


July 8, 2021

The Centers for Medicare & Medicaid Services (CMS) is required to protect the Medicare Trust Fund against inappropriate payments which pose a risk to the Trust Fund. Therefore, we are resuming Medicare Fee-for-Service medical review activities. The COVID-19 Public Health Emergency (PHE) continues to be monitored very closely. Providers should contact Provider Service at 866-360-2507 or racinfo@cotiviti.com to discuss any COVID-19 related hardships and to request any necessary extensions.


March 15, 2021

The Centers for Medicare & Medicaid Services (CMS) is required to protect the Medicare Trust Fund against inappropriate payments which pose a risk to the Trust Fund. Therefore, we are resuming Medicare Fee-for-Service medical review activities. Due to the ongoing national coronavirus disease 2019 (COVID-19) pandemic, and the potential need for providers and suppliers to allocate their resources to public health activities, we are temporarily limiting complex reviews to Dates of Service preceding March 1, 2020.


August 24, 2020

The Centers for Medicare & Medicaid Services (CMS) is required to protect the Medicare Trust Fund against inappropriate payments which pose a risk to the Trust Fund. Therefore, we are resuming Medicare Fee-for-Service medical review activities. Due to the ongoing national coronavirus disease 2019 (COVID-19) pandemic, and the potential need for providers and suppliers to allocate their resources to public health activities, we are temporarily limiting reviews to Dates of Service preceding March 1, 2020.

July 8, 2020

Please see the updated COVID-19 FAQs in the April 27th section below.

April 27, 2020

For information related to COVID-19 and the current national emergency please see the following:

CMS Current Emergencies Page

Provider Burden Relief FAQs

 
Recent update: April 8, 2019

CMS often receives referrals of potential improper payments from the MACs, UPICs, and Federal investigative agencies (e.g., OIG, DOJ). At CMS discretion, CMS may require the RAC to review claims, based on these referrals. These CMS-Required RAC reviews are conducted outside of the established ADR limits.

 
Recent update: December 11, 2018

As of Friday, December 11, 2018, access to the Provider Portal will require an email address, password, and an authentication code. For more information, please see the Provider Portal User Guide located in the "How-to materials" section.

 
Recent update: October 3, 2018

Effective October 8, 2018, our new address is:

Cotiviti, Inc.

Hillcrest III Building

731 Arbor Way, Suite 150

Blue Bell, PA 19422

Please send all correspondence to this address.  Our other contact information (phone, fax, and email) remains the same.

 

Recent update: April 23, 2018

Medicare FFS Recovery Audit Contractors (RACs) are approved by CMS to review Periodic Interim Payment (PIP) Providers under CMS New Issue #0001 MS-DRG Validation.  Claims that are selected for review will have ADRs sent within 6 months of the date of services for facilities receiving Periodic Interim Payments (PIP).

 

Recent update: January 9, 2018

As of 1/31/2018, the Region C contract will be closed and all Cotiviti provider support services for these claims will end.  As of this date, Region C claims will not be displayed on the Provider Portal and Provider Service will not be able to respond to inquiries.  If you have questions about a Region C claim(s) after 1/31/18, please contact your Medicare Administrative Contractor.  Please note:  This does not apply to Regions 2 and 3.  The auditing activity for these regions will continue.

 

March 6, 2017
Audit Activity Begins 

CMS has given approval for Cotiviti to begin audit activity for RAC Regions 2 and 3.  Click here to be taken to the CMS Approved Issues list.

Click here to see a description of prior Recovery Audit contract modifications, and their effective date(s).  

How-to materials

Use the Provider Portal

Logging in and navigation

Submit Documentation

Methods and formatting requirements

Submit a Discussion Request or Physician-to-Physician Review

Fillable Discussion Request Form
Please download and enter your request in Adobe Acrobat.

Update Your Contact Information - Individual Provider

Address, fax, email, contact of record

Update Your Contact Information - Multi-Provider

Address, fax, email, contact of record

Knowledge Base

Approved Issues

All CMS-approved reviews by type and state

RAC Frequently Asked Questions

Thorough answers to quick questions

Sample ADR

Additional documentation request from Cotiviti

Contact Us

Provider Service

(866) 360-2507
RACinfo@Cotiviti.com
(inquiries only, no medical documentation)

Provider Service Specialists are available Monday through Friday from 8:00 am to 6:30 pm EST excluding federal holidays

Fax: (203) 529-2995

 
Mailing Address

Cotiviti - CMS Recovery Audit
Hillcrest III Building
731 Arbor Way, Suite 150
Blue Bell, PA 19422

 

Program Oversight

Cotiviti CMS Recovery Audit
Program Director - Region 3
Michael Hoffman
michael.hoffman@cotiviti.com

Dr. James Lee, D.O.
Medical Director

 

Additional Information

CMS Manuals

CPI/CMS

Medicare Coverage Database

Recovery Audit Program Overview

Cotiviti.com Accessibility and Compliance with Section 508

Click to Download Adobe Acrobat Reader

 

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