Medicare Plus Blue and BCN Advantage claims audits transitioning from HMS to Cotiviti

Effective Dec. 1, 2022, Blue Cross Blue Shield of Michigan and Blue Care Network will transition their audit services from HMS to Cotiviti for Medicare Plus Blue℠ and BCN Advantage℠ claim reviews.

Here’s how the transition will work:

• For reviews already in progress, all communication will continue under the HMS name until the reviews are complete.
• As of Dec. 1, 2022, completed reviews and new requests for medical records will come directly from Cotiviti.

Note: During the transition, providers may receive communications from both HMS and Cotiviti.

Cotiviti has established relationships with several copy service companies, including MRO, Ciox, and ScanStat. Through these relationships, they acquire electronic medical records. Cotiviti also collaborates with provider groups, allowing them access to their electronic medical records.

Cotiviti typically sends requests for medical records soon after Blue Cross and BCN approve claims to be audited. Reminders are sent 30 days after the initial request and every 30 days thereafter. 

Audit and appeal determinations are sent within 50 days after provider documentation is received. The CCV includes instructions for requesting a review of the audit findings.

If you didn’t receive or have misplaced audit correspondence, contact Cotiviti Provider Services to receive a copy that will be mailed through the U.S. Postal Service.

If you have questions, need additional information or have updates to provider contact information, contact Cotiviti Provider Services at 770-379-2009 from 8 a.m. to 5 p.m. Eastern time, Monday through Friday.

HMS and Cotiviti, are independent companies that provide auditing support services for Blue Cross and BCN.