As health plan claim volumes grow amid cost increases and changing guidelines, the opportunity for inappropriate claims to slip through the cracks and get paid grows, too. Especially when plans use a siloed and disconnected approach to payment integrity.
Cotiviti's Payment Accuracy suite helps you knock down those silos by shortening time-to-results from more than 90 days to less than five with an integrated pre and postpayment program. And with dynamic solutions that can work together to review 100% of all major claim types at the right intervention point, our clients can flexibly manage their MLR and unlock more incremental savings value, with less burden on provider partners and administrative teams. Watch this short video to learn more.
Payment integrity leadership requires experience, scalability, innovation, and proven value. Cotiviti has spent 20+ years honing our solutions specifically to drive exceptional value for our clients all along the claim payment life cycle.
in medical cost savings delivered in 2022*
days until identification of savings begins**
Greater breadth and
depth of analytics
of payment rules, policies, and concepts spanning prospective and retrospective intervention points
21 of 25
top national payers are clients, with more than 100 unique payer clients total
* Individual organization results will vary based on client acceptance of identified opportunities
** Identification of savings is based on solution and receipt of a valid data file
Improve payment integrity and speed-to-value all along the continuum. Click on each icon below to learn more.
Identify millions of dollars in prospective payment savings
Payment Policy Management helps you tailor, test, and execute best-practice clinical and payment policies, ensuring compliance to avert incorrect payments.
*Estimates are based upon paid claim spend associated with volume for each claim type.
Reduce costs from clinically complex claims
Coding Validation adds a last line of defense against inappropriate claims before they are paid—for example, when editing systems pay claim lines with modifiers that override edits.
† Conservative savings with Cotiviti as incremental “final filter” to any existing code editing efforts and solutions that a client currently has in place.
Reduce the cost of inappropriate dental claims
Applying advanced clinical and coding algorithms to nationally sourced edits, Dental Claim Accuracy enables dental plans to identify and clinically validate suspect claims before they are paid.
Identify and validate potentially fraudulent or abusive claims prior to payment
Cotiviti's Claim Pattern Review solution is an automated, pre-payment, early-warning detection system used to flag providers who warrant immediate investigation.
* Based off of actual client savings. Individual results will vary.
Find more value with less administrative burden and provider abrasion
Industry-leading prospective and retrospective analytics—guided by physicians, nurses, and coders and based on clinical insights—verify that claims are supported by clinical documentation to determine reimbursement thresholds, clinical appropriateness, and proper claim payment.
Achieve greater accuracy from COB determinations
COB Validation delivers prospective and retrospective claim review for other party liability and deep and broad coordination of benefits (COB) determinations that look at more members and paid claim types, spanning across all medical products.
Save medical costs by finding undetected billing compliance issues
Cotiviti's Data Mining solution enables health plans to identify and recover billing and payment errors through advanced analytics and expert validation.
Recover an average 16 percent more with contract data alone
Contract Compliance enhances accuracy in the application of liability, coverage, and payment terms for contracted agreements. Our healthcare claims accuracy experts use proprietary analytics and data-mining tools to find overpayments that might otherwise go undetected.
Detect and deter fraud, waste, and abuse (FWA) for up to 15:1 ROI
Designed by credentialed investigators in collaboration with clinical, claims, and regulatory specialists, Cotiviti's end-to-end FWA Management solutions adapt to emerging fraud schemes and compliance requirements.
‡ Based on actual client results. Individual organization results may vary.