Date: April 23, 2025
Attention: All Providers
Subject: Cotiviti Partnership Update: New Pre-Payment Review Process Implementation
Effective date:August 5, 2025
Call to action: Texas Children’s Health Plan (TCHP) is excited to announce an important update to our partnership with Cotiviti, Inc (Cotiviti), which will help us further improve program integrity and streamline claims processing.
What’s changing?
Starting August 5, 2025, TCHP will be expanding our collaboration with Cotiviti to include pre-payment claims reviews. This new process will align our claims processing rules with Texas Medicaid requirements and national industry-standard guidelines. As part of this expansion, we will be implementing additional pre-payment claims edits to ensure correct coding, billing practices, and accurate reimbursement for services rendered.
What does this mean for you?
Cotiviti’s staff includes registered nurses, medical and claims experts with varying expertise including, but not limited to, coding, claims operations and quality. They will work collaboratively with TCHP and your staff in creating effective strategies, plans and activities to prevent both future payment errors and improving the reimbursement process. You may already be familiar with Cotiviti as a leader in the industry with health plans across the United States.
After the implementation, you may receive claims denials or payment changes based on these enhanced claim-editing concepts on your Explanation of Payments and/or electronic remittances.
Next step for providers: Please share this update with your team. If you have any questions or require additional information on this, please reach out to your assigned Provider Relations Liaison (PRL). If you are not sure who your 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.
Resources:
If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org.
For access to all provider alerts: www.texaschildrenshealthplan.org/provideralerts.
