November 4, 2025

In accordance with your participating provider agreement, and as required under Jefferson Health Plans’ contracts with the Centers for Medicare and Medicaid Services (CMS) and the Pennsylvania Department of Human Services (DHS), we maintain programs and procedures that are designed to detect and prevent fraud, waste and abuse in accordance with 42 CFR §438.608. 

This notice is to inform you that we will be replacing our current post-payment claim audit vendor, Recovery Audit Solutions (RASI), with Cotiviti, Inc. beginning on December 15, 2025. During the transition period, we have established processes to ensure claim level record requests are only made once by either vendor.  

If a claim is selected for review, you will receive a letter with detailed information on the guidelines and timeframes to follow. We request your assistance in providing Cotiviti’s staff with access to the necessary medical and/or financial information to complete these claim reviews, just as our staff would be authorized to access such records.

Cotiviti’s provider portal is called Provider Connection which requires users to create an account before using the portal. The registration process only takes a few minutes. You can access the portal here: Provider Connection Cotiviti.

Thank you for your cooperation. Please share this information with your staff as appropriate. For questions, please contact our Provider Services Helpline at 1-888-991-9023 (Mon-Fri, 9 am to 4:30 pm).