Coding Validation

Fortify your payment integrity and
further reduce annual claim spend

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Coding Validation is part of Cotiviti's
Payment Accuracy solution suite.

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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?


Discover more in payment integrity

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 claim editing, our Coding Validation solution creates additional savings of up to 1% or more of medical costs by identifying complex coding errors. We apply advanced clinical and coding algorithms to nationally sourced edits, flagging suspect claims which are then systemically and manually reviewed by coding experts before final adjudication, often without the need for medical chart review.

>$1.8B

total annual net savings

>300

RNs and certified reviewers support the solution

Low abrasion

with only 10% of providers affected by edits on average

 

Coding Validation solution benefits and features

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

  • One-stop source. Get expert clinical reviews across outpatient and inpatient claims through a single trusted source.
  • Significant incremental savings. Save up to an additional 1% or more of medical costs after primary and secondary claim editing.**
  • Customized to extend beyond the usual.  Capture inappropriate payments beyond standard modifiers, E/M, and cross-provider duplicates.
  • More same-day, prepay review. Add on additional prepay review domains, such as coordination of benefits.
  • High provider familiarity. Tap into a solution that has >50 clients representing providers in all 50 states and Puerto Rico.
  • Low disruption in claims flow. Get fast feedback, with only 1–3% of the 97–99% of claims that auto-pass through flagged for rapid nurse review within hours, often without needing medical chart review.
  • Low IT and administrative burden.  Integrate with multiple claims platforms, reducing client IT and clinical lift.

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

**Results may vary depending on factors including but not limited to usage and application.

Fortify your payment integrity to scale

Cotiviti’s Coding Validation is the longest standing, most scalable solution of its kind on the market. Our registered nurses and clinical coders have the knowledge and experience to determine a claim’s accuracy using data on the claim and claim history for fast review.

Cotiviti’s experienced 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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