Data Mining

Identify and recover billing and payment errors through data mining, using advanced analytics and specialist validation

CMS RAC

Discover more in payment integrity


Not all overpayments can be remediated before payment. While health plans strive to pay claims correctly the first time, complex policies and coding standards create challenges that can result in overpayment. When incorrect payments to providers do occur, health plans need strong analytics and pinpoint research to aid answers for recovery—without impacting critical provider relationships.  

90%
of surveyed large payer enterprise organizations agree that Cotiviti is responsive to their support needs.*

 

Cotiviti’s Data Mining solution eliminates guesswork by leveraging analytics and data mining tools to find and recover high-value overpayments.

Our specialists perform deep analyses on findings to understand why an overpayment occurred and how it can be prevented in the future. And throughout the process, Cotiviti maintains strong lines of communication with all parties involved to ensure relationships are not strained. By providing defensible and accurate evidence to providers, Cotiviti facilitates successful recoveries for clients even when high-dollar overpayments are at stake.

With this solution, our clients benefit from:

0.50%

additional savings on medical spend

$1.7B

in overpayment findings in 2022

>2,000

concepts/reports and growing

0.50%

additional savings on medical spend

$1.7B

in overpayment findings in 2022

>2,000

concepts/reports and growing

Data Mining solution benefits and features

Successful overpayment recovery requires experience, scalability, innovation, and proven value. Our Payment Data Validation solution helps your organization recover savings with benefits that include:

  • Saving up to an additional 0.50% on medical spend. Find overpayments that might otherwise go undetected with the proprietary analytics and data mining tools used by our healthcare claim accuracy specialists.
  • More value, more partnership. Get true collaboration and access to shared insights from our payment accuracy team. We can start identifying savings within 8–12 weeks from a valid data file pull.
  • Improved accuracy and provider experiences. Minimize provider impact and false positive findings with precision analytics that ensure defensible results.
  • Yield higher findings. Get insights on recovery drivers and maximize conversion rates with consultation and research. A comprehensive review covers multiple data sources, such as contract, claim, provider, and member.
  • Safeguarded information. Work with a neutral partner with no bias, committed to propelling your savings forward and protecting your intellectual property.

*Source: TechValidate. TVID: F4B-315-549

Work with a partner aligned with your goals

At Cotiviti, collaboration and precision are our goal, and the Data Mining solution is no exception. Our team configures custom claim reviews to investigate untapped billing compliance issues specific to regulations and contracted policies across product, market, and provider type. And we deliver a thorough review, focusing on claims payment compliance with a reimbursement structure to validate why errors occurred through deep analyses on postpay recovery findings. Our proven recovery management process and team helps drive superior recovery performance and significantly outperforms most collection programs. We help clients through customized claim reviews to investigate unidentified billing compliance issues, and always ensure a positive provider experience through fully validated findings and detailed communication.


Discover more in payment integrity

Data Mining is part of Cotiviti’s Payment Accuracy solution suite.

Ready to learn more? Talk to one of our sales representatives—fill out the form below to schedule a call.