Coding Validation

Fortify your payment integrity and further reduce annual claim spend

CMS RAC

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Today’s claim editing systems address black-and-white coding situations but cannot manage situation-dependent coding rules. The risk can add up to millions of dollars in improper payments. How can payers catch these complex coding errors without increasing internal workload?

96%
of surveyed payer organizations said Cotiviti is differentiated from competitors in its ability to generate greater cost savings.*

 

Get a last line of defense against coding errors with Cotiviti’s Coding Validation solution.

Even after primary and secondary automated claim editing, our Coding Validation solution creates savings of an additional 0.50% or more of medical costs due to identifying complex coding errors. We apply advanced clinical and coding algorithms to nationally sourced edits, flagging suspect claims which are then reviewed by our team of coding experts before final adjudication.

The result? We deliver results fast, rendering payment recommendations within a few hours and decreasing payment delays for your providers. Results we have delivered from individual clients include:

1%

additional annual savings for a national plan

$10M

in additional annual savings for a smaller payer

$4

per member per month in additional annual savings for a Blue Plan

Coding Validation solution benefits and features

Take a stand against improper payments and experience other benefits, such as

  • Significant incremental savings. Even after primary and secondary automated claim editing, save an additional 0.50% or more of medical costs by avoiding payment of inappropriate claims with complex coding errors.
  • Customization to extend overpayment concepts. Cotiviti customizes to specific needs to capture inappropriate payments that other editors miss—beyond standard modifiers, evaluation and management, and cross-provider duplicates.
  • More same-day, pre-pay expert review services. Our platform and processes set the foundation for adding on more pre-pay expert review domains, such as coordination of benefits.
  • Low provider abrasion. Only 10% of providers are affected by edits on average and drive the nearly 90% of denials that result in final savings. With over 20 clients representing providers in all 50 states and Puerto Rico currently participating, your provider networks are likely already exposed to Cotiviti's Coding Validation program.
  • Low disruption in claims flow. 97–99% of claims auto-pass through CV, with only 1–3% flagged for rapid nurse review within hours.
  • Low IT and administrative burden. Our managed service reduces client IT and clinical lift to maintain an editing solution, and Cotiviti’s technology integrates with multiple claims platforms.

*Source: TechValidate. TVID: 13D-4E5-FDF

Fortify your payment integrity to scale

Cotiviti’s Coding Validation is the longest standing, most scalable solution of its kind on the market. Our more than 200 registered nurse coders have the knowledge and experience to determine a claim’s accuracy using data on the claim and claim history, without cumbersome medical record review.

Cotiviti’s expert nurses and coders are certified by AAPC or AHIMA and our payment recommendations are sourced from nationally recognized coding standards to ensure that denials or payment reductions are defensible. Each team member goes through an extensive eight-month onboarding and training process and must maintain certifications in accordance with their respective professional organization’s requirements


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