Facility audits by EXLService 

As of Mar. 19, 2023, providers have one audit appeal right.

Disputing the findings

Each facility may review and agree with the findings, or review and dispute the findings. Disputes must be based on medical record and/or source documentation. Please don’t submit a replacement claim once a claim has been selected for a pre- or post-payment review.

SNF disputes

Complete the Audit Appeal Form and submit additional documentation to EXLService within 30 days of the date of that notification. EXLService will review your appeal and render a decision within 30 days. If you have questions or require additional information, contact the EXLService SNF Audit Coordinator at 833.717.0378 (ext. 57020).

HBA disputes

EXLService attempts to schedule an exit conference with each facility after an audit is complete. If an exit conference is not possible at the time of the audit, EXLService tries to schedule one with the facility within 30 days of the audit.

Respond directly to EXLService within 30 days of the audit findings letter notification date. Should you have any questions or require additional information, contact an EXLService HBA Audit Coordinator at 833.717.0378 (ext. 57077).

IBR disputes

Itemized bill review (IBR) disputes/questions should be submitted via an inquiry in our provider portal, prism. Follow the appropriate appeal process to submit.

Undisputed findings

If EXLService is unable to schedule an exit interview and the facility has not attempted to dispute the audit, the audit results are sent to Priority Health for processing.