Retrospective Claims Accuracy (RCA) Process Flow
- Cotiviti reviews finalized claims for potential findings.
- 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.
- 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.
If it's determined a claim correction is needed:
1. Do not respond to the Overpayment Notification letter.
2. Submit a claim correction immediately.