Notice About a New Payment Integrity Audit Program
Date: 04/27/21
Send requested medical records to help ensure your DRG payment is correct.
A new audit program will begin in July 2021. Selected inpatient claims and their related medical records will be audited as part of the payment integrity program. The audit ensures diagnosis related group (DRG) payments are applied using nationally correct coding rules.
Cotiviti May Contact You
Absolute Total Care has contracted with Cotiviti to help with this effort. If you have an inpatient claim selected for audit, you will receive a letter from Cotiviti listing the claim information and the medical records needed. You may receive the request for medical records before the claim is paid.
- Send in only the requested medical records to the address noted in the letter.
- An inpatient claim selected for prepay audit will be suspended for medical records. Payment is made after the medical records are received and the audit is complete. Claims payment will be denied if requested medical records are not received within the requested timeframe.
Claims Reimbursement
As a reminder, payments to contracted providers for covered services are based on contract provisions supplemented by fee schedules, payment policies and coding methodologies.
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 questions regarding the information contained in this update, contact Absolute Total Care at 1-866-433-6041. We appreciate your participation in our network and your dedication to the health and welfare of our members and your patients.