Cotiviti Completes Acquisition of Edifecs.
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We deliver accuracy across the member journey within both prepay and postpay claim review
With both prepay and postpay claim review, Cotiviti sees each member within their own context, delivering accuracy across the member's journey. Our 20+ years of expertise in this specific area allows us to identify complex payment responsibility issues beyond any payment integrity vendors and internal programs that our clients may have in place.
Coordination of Benefits (COB) Validation — Realize 80% of overpaid findings as cost savings
We correct inappropriate coding and validate suspect claims against medical records and other data
Cotiviti helps ensure pre and postpay claim accuracy by efficiently correcting inappropriate claim coding while validating other suspect claims against medical records, contract terms, and other data. With our Payment Policy Management solution as the enabling technology, Cotiviti can ingest multiple data feeds (e.g., real-time and historical claims, member eligibility, fee schedules, and provider contracts) just once for use throughout our Payment Accuracy capabilities.
Payment Policy Management — Identify millions of dollars in prepay savings
Coding Validation — Reduce costs from clinically complex claims
Data Mining and Contract Compliance — Save medical costs by finding undetected billing compliance issues
Dental Claim Accuracy — Identify suspect claims early and improve prepay dental claim integrity
Clinical Chart Validation — Save an estimated 3-4% on inpatient spend
We deliver AI-driven FWA pattern identification and management pre and post payment
In tandem with ensuring claim accuracy and determining responsibility, Cotiviti employs artificial intelligence and deterministic rules within a fully managed service model to look for patterns of potential FWA that escape detection within a claim-by-claim review.
Our 360 Pattern Review™ solution combines the power of Cotiviti's prepay Claim Pattern Review and postpay FWA Pattern Review solutions to stop FWA in its tracks:
Claim Pattern Review™ analyzes prepay claims and other data points to identify suspicious patterns and prevent inappropriate claims from being paid while still meeting prompt-pay requirements
FWA Pattern Review™ delivers high-quality leads vetted by our team of credentialed FWA experts to drive efficient postpay investigations and more recoveries