Itemized Bill Review

Review high-dollar inpatient claims with greater confidence

Detect overcharges, duplicate billing, unbundled services, and other payment inaccuracies with an itemized bill review (IBR) while reducing administrative burden and provider abrasion.

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Results

Improve inpatient claim value with one integrated review workflow

>65%

average change rate for IBRs*

<1–1.5%

provider appeals and inquiries*

*Results may vary depending on factors including but not limited to usage and application.

Simplify inpatient payment integrity without sacrificing depth

High-dollar inpatient claims can contain complex billing, coding, and documentation issues that are difficult to detect through standard claim review alone. Cotiviti’s Itemized Bill Review brings detailed billing validation into the Clinical Chart Validation workflow, helping health plans review DRG and non-DRG inpatient claims with an IBR; through one data feed, one implementation, and across multiple intervention points.

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9–12%

projected savings on inpatient claims

Discover the value of Itemized Bill Review

Bring greater precision, efficiency, and defensibility to inpatient claim reviews with an IBR while reducing operational complexity.

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Unify inpatient payment integrity

Review DRG and non-DRG inpatient claims through an integrated Clinical Chart Validation workflow that supports both prepay and postpay intervention.

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Lower administrative burden

Use one implementation and one inpatient data feed to reduce vendor management, inventory overlap, and internal operational lift.

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Increase savings opportunity

Identify overcharges, duplicative billing, unbundled services, incorrect modifiers, and other high-value errors that can drive incremental savings.

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Support defensible outcomes

Combine AI-enabled selection, certified coding expertise, nursing review, and clinical oversight to help improve provider acceptance and audit sustainability.

Cotiviti expertise

Expand inpatient review coverage with a proven payment accuracy partner

Combining DRG validation and IBR delivers comprehensive payment accuracy by aligning clinical documentation with charge details, enabling up front overpayment prevention through an integrated review workflow. Cotiviti has a seasoned history of delivering comprehensive claim review with Clinical Chart Validation, spanning complex prospective and retrospective inpatient DRG reviews, as well as postpay reviews for outpatient, skilled nursing, inpatient rehabilitation, short stay, and readmission claims.

For Blue Plan clients, the Itemized Bill Review feature also helps address itemized bill requirements for certain BlueCard claims while supporting a more complete inpatient payment integrity strategy. With one partner, one data feed, and one integrated workflow, health plans can reduce complexity while expanding savings opportunity.

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