Cotiviti named a Payment Integrity Leader by Everest Group

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Knock down silos with the right payment integration partner

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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Get more value faster from a proven leader in payment integrity

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


in medical cost savings delivered in 2022*

Faster path
to value


days until identification of savings begins**

Greater breadth and
depth of analytics


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

A trusted

21 of 25

top national payers are clients, with more than 100 unique payer clients total

* Individual organization results will vary based on client acceptance of identified opportunities

** Identification of savings is based on solution and receipt of a valid data file

Cotiviti's Payment Accuracy solutions

Improve payment integrity and speed-to-value all along the continuum. Click on each icon below to learn more.


Payment Policy Management

Identify millions of dollars in prospective payment savings

Payment Policy Management helps you tailor, test, and execute best-practice clinical and payment policies, ensuring compliance to avert incorrect payments.

  • Professional and institutional claims estimated savings of 1–3%*
  • $2.8B in annual client net savings
  • Low rates of provider appeals and inquiries

Learn more about Payment Policy Management

*Estimates are based upon paid claim spend associated with volume for each claim type.


Coding Validation

Reduce costs from clinically complex claims

Coding Validation adds a last line of defense against inappropriate claims before they are paid—for example, when editing systems pay claim lines with modifiers that override edits.

  • Save another 0.50%† off annual professional and outpatient spend incremental to a primary editor
  • 200+ nurse code reviewers
  • 500M+ prepay claims analyzed annually

Learn more about Coding Validation

† Conservative savings with Cotiviti as incremental “final filter” to any existing code editing efforts and solutions that a client currently has in place.


Dental Claim Accuracy

Reduce the cost of inappropriate dental claims

Applying advanced clinical and coding algorithms to nationally sourced edits, Dental Claim Accuracy enables dental plans to identify and clinically validate suspect claims before they are paid.

  • Save 2% or more on annual dental spend after primary editing
  • Reduce cost and efforts of postpay audit and recovery
  • Achieve total dental cost containment in a single solution

Learn more about Dental Claim Accuracy


Claim Pattern Review

Identify and validate potentially fraudulent or abusive claims prior to payment

Cotiviti's Claim Pattern Review solution is an automated, pre-payment, early-warning detection system used to flag providers who warrant immediate investigation.

  • Projected average prepay savings of ~0.30% off annual professional claim spend*
  • 50+ credentialed investigative and clinical support staff

Learn more about Claim Pattern Review

* Based off of actual client savings. Individual results will vary.


Clinical Chart Validation

Find more value with less administrative burden and provider abrasion

Industry-leading prospective and retrospective analytics—guided by physicians, nurses, and coders and based on clinical insights—verify that claims are supported by clinical documentation to determine reimbursement thresholds, clinical appropriateness, and proper claim payment.

  • Save up to >3.5% on annual DRG, short stay, and readmissions spend
  • 37% average change rate of retrospectively reviewed charts
  • 96% sustainability rates for best-in-class accuracy

Learn more about Clinical Chart Validation


Coordination of Benefits (COB) Validation

Achieve greater accuracy from COB determinations

COB Validation delivers prospective and retrospective claim review for other party liability and deep and broad coordination of benefits (COB) determinations that look at more members and paid claim types, spanning across all medical products.

  • >$745M saved by clients in 2022
  • >30% additional medical cost savings beyond internal teams and vendors
  • Trusted partner to five of the top six health plans

Learn more about COB Validation


Data Mining

Save medical costs by finding undetected billing compliance issues

Cotiviti's Data Mining solution enables health plans to identify and recover billing and payment errors through advanced analytics and expert validation.

  • >$1.7B overpayment findings in 2022
  • Save up to >0.50% on medical spend
  • Minimal 2–3% overturn rate when findings are appealed

Learn more about Data Mining


Contract Compliance

Recover an average 16 percent more with contract data alone

Contract Compliance enhances accuracy in the application of liability, coverage, and payment terms for contracted agreements. Our healthcare claims accuracy experts use proprietary analytics and data-mining tools to find overpayments that might otherwise go undetected.

  • More than $520 million of validated findings recovered in 2019, not including duplicates or pharmacy
  • 16% average increase in recoveries due to contract data alone
  • 98% provider acceptance rate with contract data versus 79% without

Learn more about Contract Compliance


Fraud, Waste, and Abuse Management

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

Designed by credentialed investigators in collaboration with clinical, claims, and regulatory specialists, Cotiviti's end-to-end FWA Management solutions adapt to emerging fraud schemes and compliance requirements.

  • Documented ROI of up to 15:1‡
  • 23+ years of experience providing FWA software solutions
  • 50+ credentialed investigative and clinical support staff

Learn more about FWA Management

‡ Based on actual client results. Individual organization results may vary.

Payment Policy

Dental Claim

Clinical Chart




Claim Pattern



Prospective Accuracy

Retrospective Accuracy

Download the Payment Accuracy brochure