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March 2024
Cotiviti to begin performing DRG cross-claim clinical reviews June 1, 2024.Cotiviti, an independent company that provides claim reviews for Blue Cross Blue Shield of Michigan, will begin performing diagnosis-related group, or DRG, cross-claim clinical reviews on Medicare Plus Blue℠ inpatient facility claims beginning June 1, 2024. The reviews are based on the member’s episode of care and will not initially require you to provide medical records. If you have claims selected for review without medical records, you’ll receive a letter advising you of the results of the review. If Cotiviti identifies an opportunity for a change, you’ll have the option to submit an appeal and provide the full medical records for consideration. Providers are able to request a first-level and a second-level appeal of the findings by the Physicians Review Organization. Questions? Contact Cotiviti Provider Relations at 770-379-2009 from 8 a.m. to 5 p.m. Eastern time, Monday through Friday.
Cotiviti is an independent company that provides auditing support services for Blue Cross and BCN. |
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