Case Study: Regional Blue Plan performs beyond hype with Data Mining

Healthcare claims must align with a myriad of best practice payment policies and nationally accepted coding standards to ensure appropriate payments. But these complex policies and coding standards can create challenges for health plans that result in high-dollar overpayments. 

Beginning in 2014, a regional Blue Plan partnered with Cotiviti after facing significant challenges in ensuring healthcare claims aligned with best practice payment policies and coding standards, often leading to high-dollar overpayments. In seeking a solution, the plan looked for strong analytics and targeted research to aid recovery without impacting critical provider relationships.