New Prepayment Audit Review Program

Date: 06/22/21

Thank you for being part of the Absolute Total Care provider network. We pride ourselves on offering our members access to quality care from valued providers. This letter is to inform you that Absolute Total Care will begin a new prepayment audit review program effective September 1, 2021. Selected laboratory, diagnostic, telemedicine, behavioral health therapy and other services will be audited as part of the payment integrity program. The claims review program will require medical records in order to confirm billing accuracy and appropriateness before the claim is paid.

Absolute Total Care, as a health insurance plan, is responsible to promptly pay providers and ensure that claims submitted for payment are accurately billed and appropriately documented. Absolute Total Care satisfies these responsibilities via prospective and retrospective reviews of submitted claims. Absolute Total Care’s Payment Integrity Dept. is one of the units engaged in such reviews. Many issues raised through these reviews involve provider coding errors or some other inadvertent mistakes, which may have resulted in erroneous payments to providers.

Cotiviti May Contact You

Absolute Total Care has contracted with Cotiviti, Inc. (Cotiviti) to conduct its claim reviews. If you receive a letter from Cotiviti requesting medical records, please send in the documentation to support billed services.

• The documentation must be submitted directly to Cotiviti within 60 days of the date of the letter requesting medical records.
• Please only submit records in response to the requests for records.
• If documentation is not submitted in a timely manner directly to Cotiviti, the related claims will be denied.

Additional Information

 

Providers are encouraged to access Absolute Total Care’s provider portal online at www.absolutetotalcare.com for real-time information, including eligibility verification, claims status, prior authorization status, and more. If you have any questions regarding this information, you may contact Provider Services at 1-866-433-6041 or contact your dedicated Provider Relations Specialist. We appreciate your participation in our network and your dedication to the health and welfare of our members and your patients.