Date: May 21, 2026
Attention: All Providers
Texas Children’s Health Plan (TCHP) would like to remind providers that appeals related to Cotiviti and EXL audits must be submitted directly to the respective vendor for review and processing.
IMPORTANT REMINDER
- Appeals for EXL audits must be submitted directly to EXL
- Appeals for Cotiviti audits must be submitted directly to Cotiviti
- TCHP is not able to process or adjudicate audit-related appeals on behalf of these vendors
Submitting appeals to the appropriate vendor helps ensure timely review and resolution of your request.
EXL Appeal Process Overview
If you do not agree with EXL audit findings, you may submit an appeal with supporting documentation within 30 days of notification:
- Level 1 Appeal: Reviewed by EXL Audit Manager
- Level 2 Appeal: Escalated review by EXL Senior Director
- Level 3 Appeal: Final review by EXL
Providers will receive a determination within 30 days of each submission.
For more information, please review the EXL Appeals Reference & EXL FAQ documents.
Cotiviti Appeal Process Overview
If you disagree with the determination, you may submit an Appeal to Cotiviti, following the instructions in the audit determination letter.
Appeals must be submitted to Cotiviti in writing via fax or US Mail to the address listed below, with additional documentation to support the request.
- US Mail: Cotiviti C/O Cotiviti-6800 731 Arbor Way Box 12017 Blue Bell, PA 19422
- FAX: 203-423-1716. This fax is in a HIPAA-secure location.
For more information, please review the Cotiviti Appeals Reference & Cotiviti FAQ documents.
What This Means for Providers
- Providers selected for audit will receive notification directly from EXL or Cotiviti
- Appeals and supporting documentation should be submitted directly to the vendor listed in the audit notification
- Timely submission is critical to ensure appropriate review
Next Steps
Providers should share this information with their billing and administrative teams, ensure internal processes are in place to route audit appeals to the appropriate vendor, and actively monitor for audit notifications to respond promptly.
Helpful Resources:
If you have any questions or require additional information, please reach out to your assigned Account Lead or Provider Relations Liaison (PRL). If you’re unsure who your Account Lead or PRL is, you can find contact details on our Meet Our Team page.
Thank you for your continued partnership as we work to improve the quality and accuracy of our claims processing.
If you have any questions, please email Provider Relations at providerrelations@texaschildrens.org.
For access to all provider alerts www.texaschildrenshealthplan.org/provideralerts.
