Self-funded health plans, which include 63% of covered workers in the United States, grapple with cost pressures similar to fully funded plans, such as inflation, increased chronic care incidence, and higher utilization rates. However, these plans can lag in adopting payment integrity measures, especially when they lack the support of a third-party administrator (TPA) that offers these services. Ensuring accurate payment of medical claims and reducing administrative waste has become crucial, with plan sponsors seeking greater transparency and accountability from their TPAs.
After initially partnering with Cotiviti in 2020 for prepay claim review and clinical auditing on fully insured claims, one large health plan expanded the scope of its relationship with Cotiviti in 2023 to include self-funded groups, acting as a benefits administrator to self-insured clients.
Read our case study to learn how this enabled the client to:
- Avoid payment errors before claims get paid
- Lower administrative costs by reducing “pay and chase”
- Maintain positive provider relationships while ensuring payment integrity
See how Cotiviti’s unique approach offers the highest incremental savings value in the market, backed by a designated clinical consultant team and an integrated prepay automated editing and clinical coding review system. Don’t miss this opportunity to see how you can achieve more accurate claim payments for self-funded plans.
