Reconsideration Process
The provider has 60 days from the date of the audit determination letter to request a reconsideration.
A request for reconsideration received by Cotiviti after the 60-day time limit has ended will result in the claim being adjusted to reflect the audit finding. Any further opportunity for reconsideration or payment of the claim is waived by the provider for failure to respond timely.
Cotiviti will review the reconsideration request along with the supporting documentation and send a reconsideration determination within 60 days from the receipt date of the request.
Reconsideration Overturned
Cotiviti agrees with the claim submission. No further action is required.
Cotiviti Reconsideration Overturned.pdf *
Reconsideration Upheld or a New Determination
Cotiviti Reconsideration Upheld.pdf *
Cotiviti Reconsideration New Determination.pdf *
Agree with determination:
Sign and return the audit determination to the address on the letter to Cotiviti within 60 days of the letter date. BCBSND will adjust the claim to reflect the audit determination within 60 days of notification from Cotiviti.
Disagree with determination:
Submit a second-level reconsideration request to BCBSND along with supporting documentation and a copy of the letter within within 60 days to:
Blue Cross Blue Shield of North Dakota
PO Box 1570
Fargo, ND 58107-1570
BCBSND provides a reconsideration determination within 60 days
- Overturned: No further action is required.
- Upheld: No further action is required. BCBSND will adjust the claim to reflect the final audit determination.
Note: If a reconsideration is not requested within 60 days, the claim will be adjusted to reflect the audit determination. Any further opportunity for reconsideration or payment of the claim is waived by the provider for failure to respond timely.
For questions on your reconsideration notice, please call Cotiviti at 770-379-2169.