Medicare AdvantageAdministrativeMedium impact
Medicare Plus Blue, BCN Advantage claim audits will transition from Cotiviti to EXL on Oct. 1, 2026
BCBS Michigan·MI·Claims & Billing
Effective date
Oct 1, 2026
We identified it
Aug 26, 2026
Summary
Effective October 1, 2026, Blue Cross Blue Shield of Michigan and Blue Care Network are transitioning retrospective audit services for Medicare Plus Blue and BCN Advantage from Cotiviti to EXL. EXL will handle DRG coding, clinical validation, inpatient rehabilitation, and readmission audits, while Cotiviti's cross-claim clinical reviews will be discontinued. During transition, providers may receive communications from both companies for ongoing reviews.
Action Required
By September 30, 2026: Billing and finance teams must update internal audit tracking systems and communication protocols to recognize EXL as the new audit vendor for Medicare Plus Blue and BCN Advantage claims. Create new contact records for EXL Provider Relations (1-833-717-0378, 8am-5pm ET, M-F). Ensure all staff understand that Cotiviti will continue handling reviews already in progress until completion, while new audit requests after Oct. 1 will come from EXL. Reinforce existing policy: do not resubmit claims involved in retrospective audits, and coordinate with finance department to hold billing on audit-related claims. No system billing rule changes are required, but documentation of the vendor transition should be recorded for compliance tracking.