Prepay claim integrity for TPAs

Save your self-funded employer clients
up to 4% on annual claim spend

Icon_CV_REVERSE

Self-funded health plans face numerous cost pressures such as inflation, greater chronic care incidence, and sharply increased utilization. They are increasingly demanding transparency and greater accountability for cost containment from their benefit administrators. You need to ensure that their medical claims are paid accurately and appropriately while lowering your administrative cost to do so.


Discover more in payment integrity

74%

of Cotiviti health plan clients with self-funded business are already integrating prepay final filter editing with self-insured employer groups

Cotiviti's prepay claim integrity solutions for third-party administrators (TPAs) are here to help.

With proven experience serving benefit administration companies covering nearly 6 million member lives, Cotiviti adds an extra layer of payment integrity for your clients that claim systems and primary claim editors are not designed to handle. Our market-leading prepay Payment Policy Management and Coding Validation solutions deliver software-as-a-service (SaaS) claim editing technology and clinical claim coding review through a consultative service model with TPAs.

This approach ensures the accuracy of claim payments for plan sponsors while reducing TPA technical and clinical resource needs without disrupting current adjudication workflow or delaying payment to providers. It also makes your service more attractive to self-funded plan sponsors and gives your organization an advantage over competing TPAs.

Every Cotiviti TPA client gets a designated clinical team led by a medical director or clinical consultant.

This model offers guidance and support through the process of data-driven policy assessment, selection, customization and maintenance. We also provide full program transparency through ad-hoc reports and insights generated from our analytics team to support payment policy approval, reduce administrative burden and understand provider and claim trends.

Trust the industry leader in prepay claim review, delivering results including:

>$5B

in annual prepay medical cost savings delivered across health plan and TPA clients1

99.9%

average editing accuracy2

4%

or more in incremental medical spend savings3 for plan sponsors

 

Key benefits

  • Avoid payment errors before claims get paid. Improve the accuracy of their claim payments to protect members and employees.
  • Lower administrative costs by reducing "pay and chase." Pay claims correctly in the first place when possible instead of undergoing the costly and potentially abrasive overpayment recovery process.
  • Maintain positive provider relationships while ensuring payment integrity. Our transparent payment policies created by expert clinicians are designed to protect your clients’ financial integrity while minimizing the potential for friction with providers.

1 Based on Cotiviti health plan clients deploying Payment Policy Management in ASO lines of business.

2 Based on savings across all Cotiviti Payment Policy Management and Coding Validation clients.

3 Based on high annual savings rates for many Cotiviti payer clients using Payment Policy Management and Coding Validation, including health plan-owned third party administrators.

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