One of the most critical aspects of using analytics in COB is the ability to pause and review claims before payment. This proactive approach involves temporarily holding claims for a detailed review to verify their accuracy and ensure correct assignment of payment responsibility. By intervening at the right time, health plans can prevent overpayments, reduce future erroneous payments, and confirm that primary payment responsibility is correctly assigned, all while lowering provider abrasion.

After partnering with Cotiviti for more than 20 years to build a payment accuracy program—including prepay claims editing, postpay data mining, and DRG review auditing—a large national payer with millions of Medicaid, Medicare, and commercial members added Cotiviti’s prepay pause-and-review process to its retrospective COB program in 2020. 

The prepay COB program launched with one of the client’s state Medicaid markets, realizing $5.2 million in savings in the first four months and exceeding projections by $1 million. Encouraged by this early success, the client quickly expanded the program, adding 11 additional state plans within the first year.

Throughout the partnership, innovation and collaboration have remained key. When internal editing logic issues arose, Cotiviti stepped in with consultative support, helping the client understand the adjudication process to ensure continuity of existing internal and external solutions.

By early 2025, the plan had expanded its prepay COB program across more Medicaid markets and into its commercial exchange line of business, with efforts underway to cover all remaining markets by year’s end. From the beginning, the quality of Cotiviti’s findings has been consistently high, enabling the plan to realize prepay savings on more than 99% of all identified claims. This success, coupled with a robust feedback loop that allows the plan to apply insights from prepay review to inform future strategies and adjustments, has reduced administrative burden and driven an estimated total COB savings of $48 million for 2025 alone.

Key results*

$48M estimated 2025 COB savings to date

>99% of identifications realized as savings

87% of all markets included in prepay COB program

Key benefits

• Rapid path from identification to revenue (30 days on average)
• Prepay-to-postpay feedback loop
• Improved conversion rates
• Reduced internal resource burden
• Increased cost avoidance

Key Cotiviti differentiators

• $805M saved by all COB clients in 2024
• Only full-service “pause-and-review” COB solution in market
• Delivers an average of an additional 30% savings beyond internal teams and other vendors
• 5 of 6 largest national payers use Cotiviti for COB 

*The results depicted are based on an individual client’s experiences and circumstances. Results may vary depending on factors including but not limited to usage and application.