Reminder: Cotiviti & EXL Audit Appeals Process

Date: June 8, 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 Guide & EXL FAQ Guide.

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 can be submitted to Cotiviti in writing via fax, electronically, or US Mail to the address listed below, with additional documentation to support the request.

FAX: 203-423-1716. This fax is in a HIPAA-secure location.
Electronically: https://providerconnection.cotiviti.com
US Mail: Cotiviti C/O Cotiviti-6800 731 Arbor Way Box 12017 Blue Bell, PA 19422

For more information, please review the Cotiviti Appeals Reference Guide & Cotiviti FAQ Guide.

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.