Data Mining

Identify and recover complex billing and payment
errors through AI/ML, advanced analytics,
and specialist validation

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

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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.


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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 AI and machine learning, analytics, and data mining tools to find and recover high-value overpayments.

Cotiviti’s specialists perform in-depth analyses to determine why an overpayment occurs and identifies opportunities to prevent them in the future. Throughout the process, Cotiviti maintains clear, consistent communication with all stakeholders to support productive provider relationships. By delivering accurate, defensible evidence, Cotiviti enables successful recoveries for clients even in complex, high-dollar scenarios.

With this solution, our clients benefit from:

~0.60%

additional savings on medical spend

$2.5B

in overpayment findings in 2025

>2,000

concepts/reports and growing

 

Data Mining solution benefits and features

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

  • Drive incremental savings on medical spend. Identify complex, high‑value overpayments that traditional claim edits often miss—delivering up to an additional 0.60% in medical spend savings through AI/ML, advanced analytics, and expert validation.
  • Accelerate time to value with a collaborative approach. Partner closely with Cotiviti’s payment accuracy experts to uncover savings opportunities quickly, with initial findings typically identified within 8–12 weeks of receiving complete data.
  • Accurate, defensible results that protect provider relationships. Reduce false positives and provider abrasion through precision analytics, specialist validation, and clear documentation that supports accurate, defensible recoveries.
  • Deeper insights to maximize recovery performance. Leverage comprehensive analysis across claims, contracts, providers, and member data to understand recovery drivers, improve conversion rates, and inform ongoing payment accuracy improvements.
  • Safeguarded information. Protect proprietary information and intellectual property while partnering with an independent organization committed to objective findings, transparency, and sustainable financial impact.

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

Work with a partner aligned with your goals

Cotiviti’s Data Mining solution is built on collaboration, precision, and results. Our team configures custom claim reviews to investigate complex billing issues, policy compliance, and adherence to contractual reimbursement terms and conditions across products, markets, and provider types. Through rigorous postpay analysis and expert validation, we identify why payment errors occur and provide clear, defensible support for recovery. Backed by a proven recovery management process, Cotiviti helps health plans achieve stronger recovery performance while maintaining a positive provider experience through transparent communication and fully validated findings. 


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