Cotiviti Completes Acquisition of Edifecs.
Read the press release.
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.
Learn more about Payment Policy Management
*Estimates are based upon paid claim spend associated with volume for each claim type.
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.
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.
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.
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.
Learn more about Claim Pattern Review
* Based off of actual client savings. Individual results will vary.
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.
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.
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.
Increase recoveries with contract data
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.
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 Pattern Review solutions adapt to emerging fraud schemes and compliance requirements.
