Oct. 24, 2023

On Sept. 1, 2022, BlueCross BlueShield of South Carolina’s Medicare Advantage plans began working with Cotiviti. Cotiviti is a leader in payment accuracy for periodic reviews of paid medical claims.

Cotiviti uses Clinical Chart Validation (CCV) to conduct post payment audit validation in the review of inpatient claims. These reviews ensure proper billing and require a copy of medical records for the following inpatient services:

• Diagnosis Related Group (DRG)
• Observation (OBV)
• Readmission (RAD)

If a claim is identified for review, you will receive a letter identifying the claim(s) selected. Details related to the guidelines and time frames to submit the required medical records will follow.

If you have any questions about the CCV audits, please call Cotiviti Provider Services at 770-379-2325. They are available Monday through Friday from 8 a.m. to 5 p.m., EST.

Cotiviti is an independent company that conducts audits on behalf of BlueCross BlueShield of South Carolina in accordance with current industry standards and practices.