Reconsideration Process
The provider has 45 days from the date of the audit determination letter to request a reconsideration.
A request for reconsideration received by Cotiviti after the 45-day time limit has ended will result in a claim denial. Any further opportunity for 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 45 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 a claim adjustment form and a copy of the letter to Cotiviti within 45 days.
Cotiviti 6750
66 East Wadsworth Park Drive
Box 12017
Draper, UT 84020
Fax: 203-642-7678
Disagree with determination:
Submit a second-level reconsideration request to BCBSND along with supporting documentation within 45 days to:
Manager of SIU/Provider Audit
Blue Cross Blue Shield of North Dakota
4510 13th Avenue S
Fargo, ND 58121
BCBSND provides a reconsideration determination within 45 days
- Overturned: No further action is required.
- Upheld: Submit a signed agreement, claim adjustment form and a copy of the final audit determination within 45 days.
Manager of SIU/Provider Audit
Blue Cross Blue Shield of North Dakota
4510 13th Avenue S
Fargo, ND 58121
Note: If a reconsideration is not requested within 45 days, rights are forfeited. The claim will be adjusted to deny, and you will receive notification on your electronic remittance advice within 45 days.
For questions on your reconsideration notice, please call Cotiviti at 770-379-2169.