Beyond prior authorization: Ensuring accuracy of specialty drug claims

Specialty drugs are in a complex area of claims processing. Almost half of specialty drug claims occur under a plan’s medical benefit rather than the pharmacy benefit. They’re also typically drugs that are administered by the provider—often intravenously—and are used for treating chronic and complex diseases. And they can be notoriously expensive.

This complexity and expense make specialty drug claims especially prone to inaccurate billing, or worse, fraud and abuse. While many plans use prior authorization to handle these claims, relying solely on this process can result in limited details that can leave plans open to inappropriate claims.

Join our Cotiviti experts as we walk through solving the complex challenges of specialty drug claims in our payment integrity webinar, Beyond prior authorization: Ensuring accuracy of specialty drug claims.

In this webinar, our specialty claim experts will discuss:

• The latest trends in specialty drug spending
• Common areas of claim errors, waste, abuse, and fraud
• Concepts to improve claim accuracy and reduce patterns of fraud and abuse