Payment Integrity Clinical Chart Validation (CCV) Implementation

Blue Cross Blue Shield of North Dakota (BCBSND) has implemented the first phase of our enhanced payment integrity program, Clinical Chart Validation (CCV) for Fully Insured, BlueCard and Medicaid Expansion.
 
The first round of CCV reviews includes a nine-month lookback period based on paid date. Claims identified in the nine-month lookback period have not been previously reviewed for DRG by BCBSND.
 
Providers will start receiving requests for medical records in early September. Medical record requests come directly from Cotiviti; but are co-branded with the BCBSND and Cotiviti logos. Providers should notify third-party vendors used to fulfill medical record requests.

Below are some key reminders for providers and third-party vendors:

• Do not invoice for any fulfillment costs; it is the provider’s responsibility to provide these at no cost to BCBSND.
• Any charges passed to Cotiviti for medical record requests are billed to you, the provider.
• Submit records within 45 days of the letter date. Failure to submit medical records results in a technical denial. 

Watch the CCV education on demand here.
 
If you have any specific questions to the program, please contact BCBSND Provider services at 800-363-2312. If you have questions on medical records, contact Cotiviti at 833-931-1789.