Changing guidelines, complex claims, and even fraud, waste, and abuse (FWA) can all contribute to the improper filing of claims. And siloed systems and disjointed processes can make these errors hard to catch. But Cotiviti’s Payment Accuracy solution suite is a seamless way to help plans get the most accurate claims through as quickly as possible for proper payment.
In five new case studies, we explore how Cotiviti’s Payment Accuracy solutions helped a variety of plans to catch improper claims for the right savings. They include:
- A national health plan growing cost containment value with end-to-end Payment Accuracy solutions, eventually gaining the opportunity to double its historical savings totals in the future.
- A New York plan gaining operational improvements and mature policy library refinement, improving accuracy of provider payments.
- A large regional plan integrating Coding Validation into an existing prepay solution, driving significant incremental savings while improving its competitive position in the marketplace.
- A large multi-state plan leveraging a highly customized policy library from Cotiviti while aligning with internal administrative guidelines and contracts.
- A plan catching a major diagnosis mismatch, using a thorough DRG review that does not require the medical record to analyze the patient journey and how it relates to the claim history.
Learn how Cotiviti’s Payment Accuracy solution suite helps plans to pay claims more accurately—while reducing the need for abrasive overpayment recovery.