Fraud, waste, and abuse (FWA) requires a robust payment integrity program. From compliance requirements and coding accuracy to the added complexity of Medicaid state regulations, bad actors are always looking for ways to slip through the cracks for their own benefit. For smaller special investigations teams (SIU) dealing with a high volume of claims, extra support helps speed along the process of catching FWA, whether simple mistakes or signs of nefarious activity.
Read our recent case study to discover how Highmark Wholecare enlisted the help of Cotiviti’s prepay FWA solution, Claim Pattern Review, preventing more than $1 million in inappropriate spending in less than a year.
The case study walks through:
- Why Highmark Wholecare was looking for FWA support
- The implementation process of setting up Claim Pattern Review
- Highmark Wholecare’s experience with the solution
Discover how Highmark Wholecare’s experience led to better payment integrity and prevented improper claim payments.
Explore the possibilities for Claim Pattern Review for your health plan. Read our fact sheet to learn how it helps payers achieve:
- Rapid ROI through automated detection while meeting prompt-pay laws
- Projected savings of 0.30% of annual professional claim spend
- Potential fraud cases identified earlier to improve payment integrity
- Increased SIU staff productivity without displacing current resources or systems
