PPCCA audits

The scope of our Post Payment Complex/Clinical Audit (PPCCA) program with vendor Performant Recovery Inc. includes the following outpatient and professional service types and impacts all plan types:

  • Outpatient diagnostic testing services
  • Outpatient surgery
  • Radiology
  • Independent labs and labs in outpatient hospitals
  • Pharmacy
  • Observation stays
  • Genetic laboratory testing

Please don’t submit a replacement claim once a claim has been selected for a pre- or post-payment review.

Level I audit disputes

As of Mar. 19, 2023, providers have one audit appeal right.
If you receive a PPCCA change notification letter from Performant Recovery Inc, one of our vendor partners, and you disagree with their findings and wish to appeal, submit an appeal within 30 days from the date of the notification letter. 

The appeal request must include evidence to support why you feel the services provided are covered and were properly coded and correctly billed. 
Include the following data elements in the appeal:

  • Claim number(s)
  • Date of this letter
  • A summary and relevant evidence for reconsideration 


Fax your appeal to 925.245.8243 or mail to:
Performant Recovery, Inc.
Attn: Appeals Dept.
P.O. Box 60410
San Angelo, TX 76906-0410