Cotiviti, Inc.

Prepay coordination of benefits (COB) boosts payment integrity results for large national plan
Learn how a Cotiviti client achieved a >99% conversion rate with prospective and retrospective COB Validation.

Discover the impact of prospective DRG validation
Learn how Clinical Chart Validation enabled one plan to streamline and optimize DRG review while improving quality and the provider experience.

eBook: Close care gaps in 12 critical areas
From HEDIS®, to Star Ratings, to member outreach and more, health plans have many priorities to tackle and limited resources to accomplish their goals. And when members receive an overwhelming amount of communications, itâ??s easy to get lost in the noise. Thatâ??s why plans need new strategies to reach their members with the right message at the right time and close care gaps when it matters most. In this new and comprehensive eBook, we explore 12 key focus areas for improving member care and quality scores with better messaging, collaboration, and prevention.

eBook: Six areas of healthcare and how to defend them against FWA
Fraud, waste, and abuse (FWA) is an area of constant concern for health plans. Whether inappropriate billing is happening purely by accident, due to lack of correct coding education, or with malicious intent from bad actors, flagging and fixing billing errors is a continual process. A strong FWA strategy is the only way to safeguard plans against inappropriate billing and ensure payment integrity. In our new eBook, we dive into several specific areas susceptible to FWA, including DME, mental health services, genetic testing, dental services, and more.

White Paper: The smart prepay approach to payment integrity
Adjudicating claims appropriately while minimizing the need to pursue overpayment recovery remains one of the greatest challenges faced by all payers. While many players in the payment integrity space offer software that enables health plans to manage their prepay claim editing of professional and outpatient facility claims, this approach only tackles one aspect of the payers entire claim stream and the payment integrity continuum. Read the new white paper from Cotiviti, a payment integrity partner to more than 100 health plans, as we break down the five critical dimensions of any payment integrity program.

Case Study: Medicaid plans leverage Eliza to reach members during redetermination
The resumption of the Medicaid redetermination process brought uncertainty for tens of millions of Americans and their health plans, many of which struggled to successfully reach their members to update contact information or assist them in finding alternative coverage. Learn how health plans of all sizes worked with Cotiviti to conduct redetermination campaigns leveraging Eliza+, Cotivitiâ??s multi-channel consumer engagement platform.

Case Study: Medicare Advantage plan reduces inappropriate payments by millions with Claim Pattern Review
Minimizing inappropriate payments while improving the efficiency of claim operations is a longstanding goal of all health plans. Thatâ??s why one Medicare Advantage plan partnered with Cotiviti, with the goal of deploying integrated prepay integrity solutions to improve payment integrity through multiple avenues. Read our new case study and learn how the plan prevented more than $1 million inappropriate payments in less than a year with Claim Pattern Review.

White Paper: Finding new opportunities to improve payment integrity with inpatient claim review
Inpatient care is one of the most expensive healthcare services, where errors in payment may delay payments, increase provider abrasion, and lower member satisfaction. But the complexity of inpatient claims often leads payers to bypass inpatient claim editing, resulting in millions of dollars in preventable overpayments for a single organization. Read our white paper for insights into how health plans can implement efficient postpay inpatient programs, apply prepayment integrity for inpatient claims to improve value, and employ best practices to reduce provider abrasion.

Case Study: How quality insights and collaboration improve quality and performance for a large nonprofit health plan
The demands of HEDIS® season are challenging enough for any health plan, but the most successful plans also use quality insights to gain an enterprise-wide commitment to continuous quality improvement. For one large nonprofit health plan based in upstate New York, this means relying on Cotivitiâ??s Quality Intelligence to support year-round initiatives across HEDIS, Star Ratings, and other quality initiatives.

White Paper: Getting self-insured employers on board with payment integrity
Self-insured employer groups, or administrative services only (ASO) partners, are increasingly managing more and more of the covered commercial population. And the pressure and demand for self-insured employer groups to have visibility into payment integrity measures implemented by the administering plan is growing rapidly. Read our white paper as we explain best practices in shaping program design and contracting, negotiating fees with self-insured employers, and engaging employer groups.