Important Provider Updates
10/13/2023: Provider Portal Service Interruption
There will be a brief interruption in service on
Thursday, October 19, 2023, at 5:00 pm PST through Friday, October 20, 2023. We apologize for any inconvenience.
Should you need any information during that period, please feel free to contact our Provider Service team between the hours of 6:00 am PST through 5:00 pm PST.
Part A Providers, including Hospital, SNF Telephone: (877) 350-7992
Part B Providers Telephone: (877) 350-7993
5/18/2023: 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.
3/30/2023: RAC 4 New Mailing Address
Cotiviti RAC 4 has relocated its mailroom processing center to a new location effective March 31, 2023.
The New Address is:
New Location:
Cotiviti RAC 4
c/o Cotiviti - 8000
10701 S Riverfront Pkwy
PO Box 12005
South Jordan, Utah 84095
Please update your records to reflect the new address and begin routing all records and correspondence to the new address effective immediately. All additional documentation request, review outcome letters and discussion period request forms will be updated to reflect the new address. Our phone numbers, email addresses and website address will remain the same.
This change will have no impact in the day-to-day contract administration and audit timelines under CMS’ guidance. All communication previously mailed to the original Draper, Utah address will be processed accordingly.
8/9/2022: Noridian's 2022 Annual Virtual Symposium - "Behind the Scenes" - September 21 and 22
Join Noridian JE/JF Medicare Administrative Contractor (MAC) for a premier Behind the Scenes view with a variety of educational productions during a two-day Virtual Symposium. Registration is required for each session - attend all presentations or choose a few.
Noridian has assembled a cast of performers that includes CMS, Contractor Medical Director (CMD), Recovery Auditor Contractor (RAC), Durable Medical Equipment (DME), Supplemental Medicare Review Contractor (SMRC), Provider Enrollment, with other Noridian departments joining the Provider Outreach and Education team.
To educate providers on the RAC Process, Cotiviti RAC 4 will present "Let's Talk RAC" focused on providing an overview of the RAC Process, on Wednesday, September 21, 2022, at 2pm EST.
An article has been posted to Noridian's website to announce the event. Registration is also showing on the Schedule of Events page. Providers can register from the Symposium Events webpage or from the Schedule of Events.
4/14/2022: Additional Documentation Limits for Medicare providers (except suppliers and physicians)
3/2/2022: HMS Federal URL (Retired) And Cotiviti GOV Services URL NEW
1/24/2022: Cotiviti RAC 4 & Noridian JE/JF MAC Web-based Workshop – February 10, 2022
12/1/2021: RAC 4 New Mailing Address
Cotiviti RAC 4 has relocated its Las Vegas office to a new location effective December 2, 2021.
The New Address is:
Cotiviti RAC 4
C/O Cotiviti-8000
66 East Wadsworth Park Drive
Box 12005
Draper, UT 84020
Please update your records to reflect the new address and begin routing all records and correspondence to the new address effective immediately. All additional documentation request, review outcome letters and discussion period request forms will be updated to reflect the new address. Our phone numbers, email addresses and website address will remain the same.
This change will have no impact in the day-to-day contract administration and audit timelines under CMS’ guidance. All communication previously mailed to the Las Vegas address will be processed accordingly.
9/27/2021: Cotiviti Region 4 Recovery Audit Contractor (RAC) and Novitas JL MAC Collaborative Webinar
To educate providers on the RAC Process, Cotiviti RAC 4 will partner with the Novitas JL Medicare Administrative Contractor (MAC) to host a Part A and Part B Webinar on Tuesday, October 5th, 2021, from 10:00 am PST - 11:00 am PST.
The Webinar will provide an overview of:
- Who and What is the RAC?
- Types of Reviews
- Medical Record Submission
- Approved RAC New Issues
- Discussion Period Process
- RAC Provider Portal Demo & “New” Direct Upload of Documentation
- Novitas’ Role in the RAC Process
- Appealing a RAC Reviewed Claim
- Reminders and Resources
Please visit the Novitas Jurisdiction L (JL) Educational Events Calendar page to register for the event before Monday, October 4th, 2021.
https://www.novitas-solutions.com/webcenter/portal/MedicareJL/pagebyid?contentId=00008010
All registrations must be completed online
Experiencing trouble accessing the Link? Contact a Novitas JL MAC Customer Service Representative for assistance at 877-235-8073
8/30/2021: Cotiviti RAC 4 & Noridian JE/JF MAC Web-based Workshop – 9/22/2021
7/8/2021: CMS Resuming Limited Complex Medical Reviews with Dates of Service(DOS) Post March 1, 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. The COVID-19 Public Health Emergency (PHE) continues to be monitored very closely. Providers should contact the Region 4 Provider Relations Team, to discuss any COVID-19 related hardships and to request any necessary extensions.
Part A: 1-877-350-7992
Part B: 1-877-350-7993
6/1/2021: Cotiviti's Acquisition of HMS RAC Region 4
On April 1, Cotiviti closed on the acquisition of a portion of HMS solutions. We are now in the process of bringing those customers, businesses, and colleagues to Cotiviti. As the teams become part of the Cotiviti family, you will see updates to the Cotiviti branding in your communications, email signatures and other items. As the integration process develops over the coming weeks and months, HMS solutions becoming a part of Cotiviti will be appropriately branded. HMS Federal, the current RAC Region 4 contractor, will now operate as Cotiviti GOV Services. This change will have no impact in the day-to-day contract administration and audit timelines under CMS’ guidance. Please continue to follow the guidance in the improper payment notification letter for submission of medical documentation and discussion period request. Our Provider Relations Team is also available to address any questions you may have regarding Region 4 Audits.
Part A: 1-877-350-7992
Part B: 1-877-350-7993
3/17/2021: HMS RAC 4 & Noridian JE/JF MAC Web-based Workshop – 4/14/2021
3/16/2021: Resuming Automated Reviews with Dates of Service (DOS) on and after March 1, 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 complex reviews to Dates of Service preceding March 1, 2020.
2/17/2021: HMS RAC 4/Novitas JL MAC Provider Outreach Webinar – 3/9/2021
To educate providers on the RAC Process, HMS will partner with the Novitas JL Medicare Administrative Contractor (MAC) to host a Part A and Part B Webinar on Tuesday, March 9th, 2021 from 10:00 AM - 11:30 AM PST.
The Webinar will provide an overview of:
- Who and What is the RAC?
- Types of Reviews
- Medical Record Submission
- Approved RAC New Issues
- Discussion Period Process
- Novitas’ Role in the RAC Process
- Appeal Levels
- RAC Provider Portal & “New” Direct Upload of Documentation
- Reminders and Resources
Please visit the Novitas Jurisdiction L (JL) Educational Events Calendar page https://www.novitas-solutions.com/webcenter/portal/MedicareJL/pagebyid?contentId=00008010https://www.novitas-solutions.com/webcenter/portal/MedicareJL/pagebyid?contentId=00008010 to register for the event before 3/8/2021.
All registrations must be completed online
Experiencing trouble accessing the Link? Contact a Novitas JL MAC Customer Service Representative for assistance.
JL Part A/B: 877-235-8073
2/11/2021: “New” Enhanced Provider Portal Functionality Enables Direct Upload of Documentation
HMS’ Region 4 RAC Provider Portal was built with you in mind. In addition to providing Region 4 providers 24-hour access to audit status, RAC issued letters, and the ability to customize your contact information, our secure, web-based application is now accepting direct uploads of medical records and discussion period review documentation.
The enhanced functionality will reduce your administrative efforts and cost by allowing direct upload of medical documentation in real time.
Please refer to the “New” HMS Provider Portal User Guide for step-by-step process on completing the Provider Portal Registration Process and Direct Upload of Documents. You may also contact a member of our Provider Relations Team for assistance at: Part A: (877) 350-7992 or Part B: (877)350-7993.
11/5/2020: HMS RAC 4 & Noridian JE/JF MAC Web-based Workshop – 12/8/2020
9/8/2020: HMS RAC 4 & Noridian JE/JF MAC Web-based Workshop – 10/12/2020
8/24/2020: CMS Resuming Medicare Fee-for-Service Review Activities Effective August 24th, 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
7/20/2020: CMS COVID-19 Provider Burden Frequently Asked Questions
HMS remains committed to supporting CMS’ program integrity medical review activities. Per CMS’ guidance, HMS will begin contacting providers to schedule postponed Discussion Period Peer-to-Peer teleconferences. Additional review activity will resume upon CMS approval. Providers are encouraged to monitor CMS’ site for updates on the 2019-Novel Coronavirus (COVID-19) public health emergency (PHE) and the new Coronavirus Disease 2019 (COVID-19) Provider Burden Relief Frequently Asked Questions (FAQs): https://www.cms.gov/files/document/provider-burden-relief-faqs.pdf. Questions regarding the FAQ should be directed to RAC@cms.hhs.gov.
3/24/2020: COVID-19 Information:
As we all continue to navigate the rapidly evolving COVID-19 situation, HMS remains available and is here to help. HMS is committed to providing the most current and up-to-date statuses for all reviews currently in progress, under CMS’ approved review guidelines. Please continue to monitor the provider portal (https://racinfo.hms.com) or contact the Provider Relations Department via email at: racinfo@hms.com or telephone at (877) 350-7992 (Part A) or (877) 350-7993 (Part B), should you have any questions regarding the status of your reviews. Above all, stay safe and healthy.
8/12/2019: HMS RAC 4 & Noridian JE/JF MAC Web-based Workshop
To educate providers on the RAC Process, HMS will partner with the Noridian JE/JF Medicare Administrative Contractor (MAC) to host a Part A and Part B Webinar on 9/12/2019 from 11:00 am – 12:00 pm Pacific Daylight Time.
The Webinar will provide an overview of:
- Review Types Performed
- Medical Record Submission
- Approved New Issues
- Discussion Period Process
- RAC 4 Provider Portal
- HMS Contact Information
- Reminders and Resources
- Noridian’s Role in the RAC Process
All registrations must be completed online via the following link:
https://attendee.gotowebinar.com/register/2335656667406485763
Experiencing trouble accessing the Link? Contact the Noridian JE/JF MAC Customer Service Department for assistance.
JE Part A/B: 855-609-9960
JF Part A/B: 877-908-8431
5/1/2019: CMS Referrals for Approved RAC Topics
3/8/2019: MS-DRG Comprehensive Coding Reviews
The Recovery Auditor is required to perform a Comprehensive Coding Review of all MS-DRG Coding claims for which an improper payment is identified, rather than a review which focuses only on code changes which impact the original DRG Code billed and paid. Review Outcome Letters have been enhanced to include the outcome of the Comprehensive Coding Review including all additional code changes, which may not impact the DRG assignment. The Comprehensive Coding Review does not change or impact a provider’s right to file a discussion period review with HMS, within 30-days from the date of the Review Outcome Letter, for those code changes which impact DRG assignment. Upon completion of the discussion period review resulting in an upheld decision or after the 30-day discussion period, if no discussion period request was filed, claims will be submitted to the MAC for adjustment, reflecting the code changes outlined in the Review Outcome Letter.
5/17/2018: Medicare Beneficiary Identifier (MBI) replacing Health Insurance Claim Number (HICN)
Effective April 2018, CMS is removing Social Security Numbers (SSNs) from all Medicare cards. A new Medicare Beneficiary Identifier (MBI) will replace the SSN-based Health Insurance Claim Number (HICN) on the new Medicare cards for Medicare transactions like billing, eligibility status, and claim status.
Providers can obtain access to the MBI by 1) Ask your Medicare Patient for their new Medicare Card 2) Use the Medicare Administrative Contractors’ (MAC) secure MBI lookup tool 3) Check the remittance advice.
As mandated by CMS, all HMS RAC 4 written communication will be updated to include the MBI. The HICN will eventually be phased out and removed from all communication. The MBI is confidential like the SSN and should be protected as Personally Identifiable Information.
Additional information on the new Medicare Cards may be found on the CMS https://www.cms.gov/Medicare/New-Medicare-Card/index.html website. You may also contact your Medicare Administrative Contractor (MAC) with questions regarding Medicare claims submission requirements.
5/8/2018: Removal of Prohibition of Recovery Audit Contractor (RAC) Reviews of Periodic Interim Payment (PIP) Providers
“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. Facilities receiving Periodic Interim Payments (PIP) will receive ADRs within 6 months of the date of service for claims under review.”
4/30/2018: HMS RAC 4 Skilled Nursing Facility (SNF) Audits - Hold Released
The hold on all SNF reviews was released effective 4/30/2018. All reviews will be completed by 6/28/2018. As the reviews are completed, a review results letter will be issued providing the outcome of the review. Please continue to monitor the Region 4 Provider portal for the status of the reviews.
4/20/2018: HMS RAC 4 Skilled Nursing Facility (SNF) Audits
As approved by CMS, all Region 4 Skilled Nursing Facility (SNF) Complex Reviews are temporarily on hold. CMS has granted HMS an extension to perform the reviews after the hold is released. Providers are still required to follow the medical record submission timeframes outlined in the Additional Documentation Request Letter.
Please continue to monitor the Region 4 Provider Portal for updates on when the hold is released. We appreciate your patience during the review period.
2/6/2018: Refund Checks for RAC Identified Improper Payments
Refund checks for RAC Identified Improper Payments should not be sent to the RAC or the Medicare Administrative Contractor (MAC) upon receipt of the Informational Letters for an automated review, Review Results Letter for a complex review or the discussion period review outcome letter. Instead, Providers should wait to receive a demand letter, from the MAC, which identifies the improper payment amount and outlines repayment options.
As a reminder, refund checks should never be sent to the RAC, but can be submitted to your MAC, after you receive a demand letter.
7/5/2017: HMS Provider Portal Contact Customization
The HMS Provider Portal is available for all Region 4 Providers in the JL, JE and JF MAC Regions to customize their contact information. Provider Portal User Guides are available on the homepage, under Links and Resources, to assist Providers with establishing their user credentials and customizing their contact information. Providers may also contact HMS' Provider Relations Department for assistance.
HMS has received CMS approval to initiate review in the Novitas JL MAC Region.
5/18/2017: RAC 4 Audits
HMS Region 4 RAC has received CMS approval to begin audits for the Noridian JE and JF MAC Part A and Part B Jurisdiction.
5/15/2017: Provider Outreach Presentations
The HMS Region 4 Part A and Part B Provider Outreach Presentations are now located under the "Links & Resourcces" on the home page.
Please continue to monitor the Provider Portal for updates on when HMS will initiate reviews in Region 4.
4/12/2017: HMS Awarded Region 4 Recovery Audit Contract
On October 31st, 2016, CMS awarded HMS Federal Solutions (HMS), a wholly owned subsidiary of HMS Holdings Corporation, the Region 4 Recovery Audit Contractor (RAC) contract. As the Region 4 RAC, HMS will perform postpayment reviews to identify improper payments (overpayment and underpayments) that were made on all Part A and Part B Medicare claims for all provider types. Additional updates related to Region 4 RAC reviews will be posted to this website as HMS implements the RAC Program in Region 4.
Please refer to the following link for the map of the Medicare Fee-for-Service RAC Regions and related RACS.
Medicare Fee-for-Service RAC Region Map Selecting this link will open a new window.