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Payment integrity

Our Payment Integrity Process

At Devoted Health, we aim to ensure the accuracy and integrity of our payment process while supporting you in every step. We conduct prepay and postpay audits to maintain the integrity of our claims processing. Audits will analyze claims data for patterns and anomalies and/or validate the medical coding and billing associated with specific claims.

  • Prepay audits: These audits happen before a claim is paid.
  • Postpay audits: These audits occur after a claim has been paid.

For more information on payment integrity at Devoted, see our Provider Manual.

Medical Record Requests

We will request medical records if we are conducting a Clinical and Coding Validation (CCV) Audit. If there are not already suitable medical records on file, you will receive a documentation request letter from our internal Payment Integrity (PI) team or through our trusted vendors.

  • For Prepay CCV Audits, you will receive one medical record request letter.
  • For Postpay CCV Audits, you may receive up to three medical record request letters.

This page will cover how to respond to medical records requests and provide details on how results will be communicated.

Timeframes for responding to medical record requests

  • For Prepay CCV Audits: Records must be received within 30 days of the date on the medical request letter or according to your contract guidelines.
  • For Postpay CCV Audits: Records must be received within 30 days of the date on the medical request letter (you will have three chances to submit records) or according to your contract guidelines.

How to respond to medical record requests from Devoted

You can submit medical records requested by Devoted through several methods:

Via Fax

Securely send your documents to Devoted Health at: (866) 312-3986

Via Mail

Devoted Health Payment Integrity Department

PO BOX 211524

Eagan, MN 55121

Please mark the envelope as “Confidential" and send via USPS to ensure delivery. Some mail carriers don’t deliver to PO boxes.

Via the Devoted Provider Portal
  1. Login to the Devoted provider portal via the Devoted Health Payer Space in Availity. For more information about using our provider portal, see our website here.
  2. Once on the portal homepage, navigate to “Claims Requiring Additional Documentation” for the full list of adjudications we’ve requested medical records for. If the audit is being conducted by a vendor, the adjudications for which vendors have requested medical records will NOT be shown on the provider portal.
  3. Select “Attach medical documentation” on the right for each adjudication that requires medical records. Note: providers should ONLY submit the medical records requested for the claim audit associated with the adjudication. Records should contain at least a couple of identifying demographics (e.g., DOB, member name).
  4. Click “Ok”. You will be able to see the name of the submitted file to confirm the upload was successful. The button to upload medical records for that adjudication will remain visible for approximately one hour. After that, the button will disappear if the upload was successful.

Results of medical record submission to Devoted

If Devoted determines these records are sufficient for the request, the audit will proceed. If we determine that these records are not applicable for the audit request, one of the following will occur:

  • For postpay audits only, if the audit is eligible for another medical record request, you will receive another request and the adjudication will reappear in the Devoted provider portal.
  • If medical record requests have been exhausted and the audit is eligible to submit records following a technical denial, the adjudication will reappear in the provider portal.
  • If medical record requests have been exhausted and the audit is no longer eligible to submit records after a technical denial, the adjudication will not appear in the provider portal.

How to respond to medical record requests from our vendors

If the audit is being conducted by one of our vendors, please follow the specific instructions provided in their request letter. Instructions are summarized below for quick reference:

Cotiviti

EXL

Optum

For prepay medical records requests, an initial request is sent followed by a reminder when there are 15 days left for record submission.

For FCRI / Facility Audits - for questions, please call: (833) 833-2093

  • CIOX e-portal
  • Fax: (949) 315-7942
  • Secure online file drop: facilitydrop.com
  • USPS mail:
    Attn: Optum Health
    c/o Devoted Health Plan
    16350 Bake Pkwy.
    Irvine, CA 92618

For FCR Professional Audits

  • Fax: (844) 226-3364

Penstock
  • Provider portal: Hubshare (first-time users should email Devoted_service_desk@penstockgroup.com for account setup)
  • Regular mail:
    Penstock Group, LLC
    Attn: Devoted Document Imaging Center
    PO Box 1370
    Williamsville, NY 14231
  • Overnight delivery (FEDEX, UPS, etc.):
    Penstock Group, LLC
    Attn: Devoted Document Imaging Center
    5325 Sheridan Drive, Suite 1370
    Williamsville, NY 14221
    Fax: (860) 435-7020

Results of medical record submission to a vendor

If there are findings for a prepay or postpay audit performed by a vendor, you will receive a findings letter from them.

For more information on our claims process, visit our claims webpage.

Contact Us

Have questions? Call us at 1-877-762-3515, 8am to 5pm, local time.