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Fraud, Waste, and Abuse (FWA) Validation solution

Prevent FWA before claims are paid and flag providers that warrant immediate investigation

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Cotiviti’s prospective FWA Validation solution identifies potential patterns of FWA early in the process to prevent fraudulent claims from being paid while still meeting prompt-pay requirements. Our solution flags suspicious providers that warrant immediate investigation and creates and “Index of Suspicion” for every provider and their patterns around at-risk dollars. Backed by highly experienced and accredited staff, our solution delivered a 14:1 ROI for one Managed Medicaid client.

  • Identify claims tied to aberrant provider patterns in utilization, coding mismatches, and outlier billing activities
  • Apply retrospective learnings prospectively
  • Meet prompt-pay requirements to avoid fines and penalties