As health plans increasingly adopt formal prepay fraud, waste, and abuse (FWA) programs, many still face challenges such as limited resources, unsatisfactory results, or uncertainty about where to begin. For Highmark Wholecare, finding a solution that would complement the health plan’s existing special investigations unit (SIU) without increasing the team’s workload was critical.
We invite you to join Cotiviti and Highmark Wholecare for our on-demand webinar focusing on lessons learned from a successful prepay FWA program. You’ll learn more about Highmark Wholecare’s implementation of Cotiviti’s Claim Pattern Review solution, which led to success in identifying and preventing improper claims across critical areas such as durable medical equipment (DME) and more. The collaboration also allowed the health plan to proactively flag and address potentially fraudulent billing behaviors, all while maintaining high accuracy and low appeal rates from providers.
Join us for a deep dive into Highmark’s case study and gain:
- A clear understanding of Highmark Wholecare’s strategy for preventing improper claims while seamlessly referring verified fraud leads to the SIU
- Insights into the top areas of abuse that can be effectively addressed in the prepay stage
- Practical guidance on reviewing providers that have been flagged using artificial intelligence and deterministic algorithms before claim payment
Don't miss this opportunity to learn from industry leaders and strengthen your FWA efforts.
