Retrospective Claims Accuracy (RCA) Process Flow

Overpayment Notice

  1. Cotiviti reviews finalized claims for potential findings.

  2. Once a claim has been identified as overpaid, Cotiviti may send a written notice of overpayment. The letter contains an explanation of Cotiviti’s findings along with a remittance coupon to complete and return to Cotiviti.

  3. Complete and return the remittance coupon to Cotiviti within 45 days.
    Cotiviti Overpayment Notice Non-Par Sample.pdf *
    Cotiviti Overpayment Notice Par Sample.pdf *

Agree with Overpayment Findings: Circle "Yes" on the remittance coupon

Participating providers:

1. Return the Remittance Coupon to Cotiviti
Cotiviti, Inc.
Attn: Claims Review – HC BCBSND Correspondence Team
Hillcrest Building
731 Arbor Way, Suite 150
Blue Bell, PA 19422

2. The claim will be adjusted to deny and you will receive a notification on your electronic remittance advice within 45 days.


Nonparticipating providers:

1. Return the remittance coupon to Cotiviti.
Cotiviti, Inc.
Attn: Claims Review—HC BCBSND Correspondence Team
Hillcrest Building
731 Arbor Way, Suite 150
Blue Bell, PA 19422

2. Send a copy of the letter and a refund check to:
Blue Cross Blue Shield of North Dakota
RE: Cotiviti, Inc.
4510 13th Ave S
Fargo ND 58121

Disagree With Overpayment Findings: Circle "No" on the Remittance Coupon and Return to Cotiviti

Include rationale, coding changes and supporting documentation. (DO NOT SUBMIT A CLAIM CORRECTION)
Cotiviti, Inc.
Attn: Claims Review—HC BCBSND Correspondence Team
Hillcrest Building
731 Arbor Way, Suite 150
Blue Bell, PA 19422

Note: If a reconsideration is not requested within 45 days, reconsideration 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 overpayment notice, please call Cotiviti at 203-529-9411.

Reconsideration Process

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. The letter contains an explanation of Cotiviti’s findings along with a remittance coupon to complete and return to Cotiviti.

Reconsideration Sample Letter.pdf *

Reconsideration Overturned

  • If a claim correction was requested with your reconsideration, you can submit the claim correction at this time.
  • If a claim correction was not requested, there’s no further action.

Reconsideration Upheld

Agree with upheld determination: Circle "Yes" on the remittance coupon

Participating providers:

1. Return the Remittance Coupon to Cotiviti
Cotiviti, Inc.
Attn: Claims Review -– HC BCBSND Correspondence Team
Hillcrest Building
731 Arbor Way, Suite 150
Blue Bell, PA 19422
Fax: 1-203-642-7678

2. The claim will be adjusted to deny, and you will receive notification on your electronic remittance advice within 45 days.

Nonparticipating providers:

1. Return the remittance coupon to Cotiviti.
Cotiviti, Inc.
Attn: Claims Review—HC BCBSND Correspondence Team
Hillcrest Building
731 Arbor Way, Suite 150
Blue Bell, PA 19422
Fax: 203-642-7678

2. Send a copy of the letter and a refund check to:
Blue Cross Blue Shield of North Dakota
RE: Cotiviti, Inc.
4510 13th Ave S
Fargo ND 58121


Disagree with upheld determination: Circle "No" on the remittance coupon and return to Cotiviti

1. Return the remittance coupon to Cotiviti
Cotiviti, Inc.
Attn: Claims Review—HC BCBSND Correspondence Team
Hillcrest Building
731 Arbor Way, Suite 150
Blue Bell, PA 19422|
Fax: 203-642-7678

2. Submit a second-level reconsideration along with supporting documentation within 45 days.
Blue Cross Blue Shield of North Dakota
PO Box 1570
Fargo, ND 58107-1570
Fax: 701-277-2209

Note: If a reconsideration is not requested within 45 days, reconsideration 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 203-529-9411.

When To Submit a Claim Correction

Providers should include claim correction requests when requesting a reconsideration to Cotiviti. If Cotiviti reviews your request and determines the claim correction change is appropriate, they will respond with a favorable reconsideration notice. A claim correction (frequency 7) can be submitted upon receiving the reconsideration notice. Claim corrections submitted outside of this process may be rejected.

If a claim correction is requested after the overpayment notice has been issued, rather than requesting a reconsideration, this will be treated as a reconsideration request and reviewed without supporting documentation.

*Sample letter verbiage is subject to change. These images are just samples of the letters you or your administration may see.