Contract Compliance

Boost savings by confirming compliance with complex payment contractual terms and regulations


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Contractual terms, prompt pay laws, other state regulations—they all form the foundations on which healthcare claims should be quickly and accurately reimbursed per your providers’ agreements. Add another layer of complex compliance: payers must keep data safe and follow regulatory mandates such as HIPAA, HITECH, and SOC. How can your organization check all of the necessary boxes to ensure claims are paid properly and in compliance?

of surveyed payer organizations said Cotiviti is differentiated when asked about Cotiviti’s ability to generate greater cost savings compared to the competition.*


Cotiviti’s Contract Compliance solution helps cut through the complexity of multi-layered regulations.

Contract Compliance enhances accuracy while applying liability, coverage, and payment terms for contracted agreements. Our healthcare claim accuracy experts use proprietary analytics and data-mining tools to find overpayments that might otherwise go undetected. We work with our clients to configure claim reviews specific to relevant regulation and contracted policy. When we identify an error, we provide clients with full details and supporting documentation, working closely with them to facilitate recovery—all with minimum disruption to providers and network relationships.

With this solution, our clients benefit from:


of validated findings recovered in 2019


average increase in recoveries due to contract data alone


provider acceptance rate with contract data versus 79% without

Contract Compliance solution benefits and features

With Cotiviti's Contract Compliance, your organization can cut through the intricacies of compliance and offer benefits such as:

  • Significant savings. Get the possibility of an additional medical cost savings opportunity of 0.3% of medical spend over/above our premium postpay Data Mining solution.
  • Unique offering in the market. Benefit from Cotiviti’s ability to uncover payment issues based on advanced contractual and payment requirements, including state payment policy alignment. This enables Cotiviti to deliver superior cost savings.
  • Improved accuracy. Get better accuracy with a combination of analytics, expert reviewers, and ancillary data sources. We minimize provider abrasion by ensuring that each payment request, denial, or change is defensible—and each chart request has a high likelihood of a finding.
  • Unmatched breadth of experience. Count on our experts to deliver results. We deploy overpayment analytics developed, tested, and honed over 20+ years across multiple payers and all lines of business to bring immediate value to new clients.
  • Integrated recovery management and appeals. Reduce administrative burden with findings validation, offset management support, recovery management and first- and second-level appeals support.

*Source: TechValidate. TVID: EB1-6B9-A2E

Work with dedicated experts

Looking for experts who can handle contractual complexity? Cotiviti’s talented subject matter experts combine industry knowledge with an advanced understanding of your operating environment and strategic priorities to provide exceptional results. Our specialty auditors focus on claim payment compliance with contractual rate and reimbursement language. The audit team conducts root-cause analysis on postpay recovery findings to understand why errors occurred and prevent them from happening again. Closed-loop resolution reviews, system updates, and contractual amendments combine with system load revisions and provider network management to continuously improve payment accuracy and speed.

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