Your challenges
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Our answers
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Claims with over-coded E&M’s or misused modifiers slip through your editing system and get paid
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Cotiviti’s Clinical Validation solution adds an extra layer of review to automated editing to analyze the most complex claims pre-pay.
- Expert nurse coders render a payment decision immediately
- Payment recommendations sourced from nationally recognized coding standards to ensure denials or reductions are defensible
- Editing and payment guidelines automatically updated by Cotiviti through our SaaS offering
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Your SIU team is understaffed and overburdened
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Cotiviti’s FWA Solutions provide end-to-end support for preventing and catching fraud, waste, and abuse.
- Use in combination or standalone for maximum flexibility
- Catch FWA both pre-pay and post-pay
- Includes SIU Services offering investigative support, clinical review, claim verification, and consultation
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Identifying and recovering overpayments requires extensive review of complex contractual terms
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Cotiviti’s Contract Compliance solution enhances accuracy in the application of liability, coverage, and payment terms for contracted agreements.
- Precision analytics leveraged within each client’s payment integrity program deliver innovative overpayment findings yielding higher savings
- Safeguard contract compliance at every point in the claim payment cycle
- Stay price competitive while improving member satisfaction with the billing process
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Post-pay chart review is too costly and causes significant provider abrasion
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Cotiviti’s Clinical Chart Validation solution is driven by analytics to focus on only those charts most likely to generate value.
- Isolate charts with the highest probability of overpayment
- Catch higher-value errors that others miss with coding, documentation, and clinical validation
- Full-time medical directors lead reviews and appeals conducted by nursing and coding teams with significant credentials and extensive experience
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