Payment Accuracy solutions

Unlock new value with integrated prospective and
retrospective payment integrity solutions

CMS RAC

As health plan claim volumes grow amid cost increases and changing guidelines, the opportunity for inappropriate claims to slip through the cracks and get paid grows, too. Especially when plans use a siloed and disconnected approach to payment integrity.

Cotiviti's Payment Accuracy suite helps you knock down those silos by shortening time-to-results from more than 90 days to less than five with an integrated pre and postpayment program. And with dynamic solutions that can work together to review 100% of all major claim types at the right intervention point, our clients can flexibly manage their MLR and unlock more incremental savings value, with less burden on provider partners and administrative teams. Watch this short video to learn more.

 
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From the Cotiviti blog

COVID-19 claim editing resources for health plans

Cotiviti has compiled a summary of the latest COVID-19 guidelines as a resource for health plans to quickly find the most relevant information needed to ensure payment policies are up to date.

Read the blog

 

Payment integrity leadership requires experience, scalability, innovation, and proven value. Cotiviti has spent 20+ years honing our solutions specifically to drive exceptional value for our clients all along the claim payment life cycle.


More savings opportunities

>$7B

in medical cost savings delivered in 2021*

Faster path to value

60-120

days until identification of savings begins**

Greater breadth and depth of analytics

1000s

of payment rules, policies, and concepts spanning prospective and retrospective intervention points

A trusted partner

21 of the top 25

national payers are clients, with nearly 100 unique payer clients total

* Based on recent, actual client-accepted savings across our portfolio. Individual organization results will vary based on client acceptance of identified opportunities and policies.

** Some Cotiviti post-pay solutions are able to start identifying savings 8–12 weeks from receipt of a valid data file. Payment Policy Management averages about 150 days for real-time implementation, depending on client resources.

Improve payment integrity and speed-to-value all along the continuum

 

Chart Payment Accuracy

 

payment_accuracy_solution_pament-policy-managementPayment Policy Management

Identify millions of dollars in prospective payment savings

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payment_accuracy_solution_clinical_validationCoding Validation

Reduce costs from clinically complex claims

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payment_accuracy_solution_clinical_validationDental Claim Accuracy

Reduce the cost of inappropriate dental claims

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payment_accuracy_solution_fwa_validationFraud, Waste, and Abuse (FWA) Validation

Identify and validate potentially fraudulent or abusive claims prior to payment

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payment_accuracy_solution_clinical_chart_validationClinical Chart Validation

Save 1 to 2 percent of DRG spend with comprehensive medical record review services

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payment_accuracy_solution_payment_responsibilityCoordination of Benefits (COB) Validation

Realize 80 percent of overpaid findings as cost savings

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payment_accuracy_solution_payment_data_validationData Mining

Save medical costs by finding undetected billing compliance issues

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payment_accuracy_solution_contract_complianceContract Compliance 

Recover an average 16 percent more with contract data alone

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payment_accuracy_solution_fraud_waste_abuse_solutionsFraud, Waste, and Abuse Management

Detect and deter fraud, waste, and abuse (FWA) for up to 15:1 ROI

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Download the Payment Accuracy brochure