NORTHGATE PAYMENT INTEGRITY
Post-Payment Review Unit - 400 Harbor Plaza, Suite 1200, Lakeshore City, MI 48000
Fax: (555) 010-2231

On behalf of Lakeshore Health Plan (behavioral health)

September 21, 2026

Cedar Row Counseling
Attn: Billing / Medical Records
Provider: Dana Whitfield, LCSW

RE: Medical records request - post-payment review
Review reference: NPI-PPR-2026-0418

Dear Provider,

Lakeshore Health Plan has selected 12 claims billed by your practice for post-payment review. Please send the complete
progress note for each date of service listed in Attachment A, including any signatures, addenda and attachments.
Records will be reviewed against the plan's behavioral health medical record documentation requirements for individual
therapy.

Please respond within ten (10) calendar days of the date of this letter. Records may be faxed to (555) 010-2231 or uploaded
at the provider portal under the reference number above. If records are not received, the claims may be denied and the
payments recovered.

Sincerely,
Records Review Coordinator
Northgate Payment Integrity

Attachment A - Claims selected for review

| # | Member | Member ID | Claim number | Date of service | Billed code |
|---|---|---|---|---|---|
| 1 | Ashworth, T. | LHP1328919 | 26009450370 | 01/09/2026 | 90837 |
| 2 | Galvan, R. | LHP4378198 | 26009998616 | 01/09/2026 | 90837 |
| 3 | Hollins, D. | LHP4689057 | 26009877633 | 01/09/2026 | 90837 |
| 4 | Salazar, J. | LHP8080983 | 26015449576 | 01/15/2026 | 90837 |
| 5 | Whitcombe, G. | LHP2626587 | 26015928628 | 01/15/2026 | 90834 |
| 6 | Ferreira, L. | LHP6630683 | 26016977292 | 01/16/2026 | 90837 |
| 7 | Novak, D. | LHP7391720 | 26016208661 | 01/16/2026 | 90837 |
| 8 | Castellanos, Y. | LHP3665714 | 26019468237 | 01/19/2026 | 90834 |
| 9 | Haddad, A. | LHP7066349 | 26021987618 | 01/21/2026 | 90837 |
| 10 | Ashworth, T. | LHP1328919 | 26044161853 | 02/13/2026 | 90837 |
| 11 | Castellanos, Y. | LHP3665714 | 26054210670 | 02/23/2026 | 90834 |
| 12 | Qureshi, T. | LHP7134942 | 26072465252 | 03/13/2026 | 90837 |
