Facility audits by EXLService
Level I facility audits
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.
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.
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.
Level II facility audits
If you have exhausted the EXLService process and you still disagree with the findings, submit your dispute to the Priority Health Payment Integrity department within 45 days of receipt of EXLService's response.
Include the following information:
- Copies of the initial audit findings, your appeal letter and the EXLService response if available
- Documentation/summary of why you disagree with the findings and/or interpretation of a guideline
- Pertinent pieces of the medical record that support your dispute (NOT the complete medical record)
- Query documentation if appropriate
- References that support your dispute
Submitting your dispute
Send your dispute to Priority Health at:
Mail: Priority Health
Attn: Payment Integrity MS 2205
1231 East Beltline NE
Grand Rapids, MI 49525