Introducing Cotiviti's 360 Pattern Review

Health plans special investigations units (SIUs) often face significant challenges such as overwhelmed or insufficient staff, disparate record systems, and incomplete reports or data sets in their fight against fraud, waste, and abuse (FWA). Many plans employ homegrown solutions or limited identification software, which frequently results in the need to sift through false-positive leads, wasting valuable time and resources. Moreover, implementing many of the FWA solutions currently available in the marketplace would require substantial disruption to existing teams and systems.

Cotiviti's 360 Pattern Review offers comprehensive FWA prevention and management across the entire claim payment cycle, seamlessly integrating with your existing programs and personnel. Our solution merges the capabilities of Cotiviti’s prepay and postpay solutions to effectively combat FWA:

• Claim Pattern Review scrutinizes prepay claims and other data points to identify suspicious patterns, preventing inappropriate claims from being paid while still adhering to prompt-pay requirements.
• FWA Pattern Review provides high-quality leads vetted by our credentialed FWA experts, driving efficient postpay investigations and increasing recoveries.

Watch our video and join the evolution of FWA prevention and recovery.