DRG, APC, Clinical Validation and Readmission Guideline audits by VARIS, LLC
Please don’t submit a replacement claim once a claim has been selected for a pre- or post-payment review.
Level I audit disputes
As of Mar. 19, 2023, providers have one audit appeal right.
If you receive a DRG or APC change notification letter from VARIS, LLC, one of our vendor partners, and you disagree with their findings:
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Complete the acknowledgement form
VARIS sends the acknowledgement form along with your change notification letter. With the form, you'll need to submit additional or clarifying information to VARIS within 30 days of receipt of audit findings. If you don't have the form, you can contact VARIS by phone at 916.294.0860.
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Document the points of your disagreement
In addition to the acknowledgement form, include:
An explanation of why you disagree with the findings and/or the interpretation of a guideline
Sections of the medical record that support your dispute (NOT the complete medical record)
Query documentation if appropriate
References as needed to support your dispute
Submitting your form
Send your acknowledgement form and documentation to VARIS via:
Email: appeals@varis1.com
Phone: 916.294.0860
Fax: 916.294.0844
Mail: VARIS, LLC
9245 Sierra College Blvd. Ste 100
Roseville, CA 95661
SFTP: Must be established with VARIS, LLC in advance
Technical denials
For each claim requiring medical record review, three request letters are sent. When a provider doesn’t respond to these requests – whether from Priority Health or one of our vendors – by the deadline, we’re unable to substantiate the care provided and will issue a technical denial.
This is a denial of the entire paid claim, after which we'll recoup funds following our standard process for correcting overpayments.
To dispute a technical denial, follow the appeal process for the appropriate audit type.