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 sends 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 Par Sample.pdf *

Agree with Overpayment Findings

1. Circle "Yes" on the remittance coupon and return to the address on the Overpayment Notification letter.

2. The claim will be adjusted within 60 days and you will receive a notification on your electronic remittance advice.


Disagree With Overpayment Findings

1. Circle "No" on the Remittance Coupon and return to the address on the Overpayment Notification letter. Include rationale and supporting documentation.

Note: If a reconsideration is not requested within 45 days, reconsideration rights are forfeited. The claim will be adjusted to reflect the audit determination and you will receive notification on your electronic remittance advice.

For questions on your overpayment notice, please call Cotiviti at 203-529-4199.


Claim Correction

If it's determined a claim correction is needed:

1. Do not respond to the Overpayment Notification letter.

2. Submit a claim correction immediately.

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

  • Cotiviti agress with the claim submission. No further action is required.

Reconsideration Upheld

Agree with upheld determination

1. Circle "Yes" on the remittance coupon and return the Remittance Coupon to the address provided on the Reconsideration determination.

2. The claim will be adjusted within 60 days and you will receive notification on your electronic remittance advice.


Disagree with upheld determination

1. Circle "No" on the remittance coupon and return to teh address on the Reconsideration determination.

2. Submit a second-level reconsideration along with rationale and 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 reflect the audit determination and you will receive notification on your electronic remittance advice.

For questions on your reconsideration notice, please call Cotiviti at 203-529-4199.

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