CommercialAdministrativeMedium impact
21-045 Notice About a New Payment Integrity Audit Program
Health Net·CA · Critical Care, Emergency Medicine, Anesthesiology·Reimbursement
Effective date
Mar 1, 2021
We identified it
Jun 20, 2026
Summary
Health Net is launching a new audit program in March 2021 where Cotiviti will review inpatient claims to verify DRG payments using correct coding standards. Hospitals must respond to medical record requests from Cotiviti for selected inpatient claims, which may occur before or after payment.
Action Required
Starting March 2021: Hospital billing teams must respond promptly to medical record requests from Cotiviti for inpatient claims audits. When contacted, send only the specific medical records requested to the address provided in Cotiviti's letter. Be aware that prepay audits will hold payment until records are received and audit is complete.