Find more value from clinical review and clinical validation—with less administrative burden and provider abrasion
Discover more in payment integrity
Coding and documentation review only scratches the surface of clinical chart validation. Although coding errors and documentation issues are important to catch, they don’t always add up to high-cost overpayments. And when payers concentrate on reviewing as many charts as possible, they waste time and resources, risking provider relationships by addressing overpayments with low returns on investment.
93%
of surveyed payer organizations are likely to recommend Cotiviti.*
Our Clinical Chart Validation solution goes beyond the usual coding review to provide a holistic, clinical review that thoroughly analyzes charts to provide better savings. And this solution provides capabilities for both the prospective and retrospective clinical review and validation of claims, delivering results no matter where payers are in the process.
96%
sustainability rates for best-in-class accuracy
50%
or greater change rate for prospectively reviewed charts
4%
average savings on DRG, short stay, and readmissions spend
sustainability rates for best-in-class accuracy
or greater change rate for prospectively reviewed charts
average savings on DRG, short stay, and readmissions spend
Our industry-leading team uses machine learning to help isolate charts with the highest probability of overpayment of inpatient DRGs, short stays, and readmissions. And deeper analysis combines coding, documentation, and clinical chart reviews to reveal high-value errors that others miss. We drive improved results through:
*Source: TechValidate. TVID: C55-FBC-364
The Clinical Chart Validation solution provides capabilities for both the prospective and retrospective clinical review and validation of inpatient Diagnostic Related Group (DRG), Short Stay (SS), and readmission claims. It utilizes an integrated process that assures appropriate DRG-assignment and payment of inpatient hospital claims by reviewing the patient medical record in accordance with the payer’s claim payment data, while working to maintain and promote positive provider relations. The solution provides these services for Commercial, Medicare, and Medicaid lines of business.
Clinical Chart Validation is part of Cotiviti’s Payment Accuracy solution suite.
