A large health plan operating in multiple states optimized its payment integrity program by performing edits at strategic intervention points along the prepay-to-postpay continuum. This environment is layered in complexity, and the plan relied on multiple claims editing systems for success, including an in-house solution and customized code edits. For improved success, the plan enlisted the help of Cotiviti as a third-party expert, relying upon Cotiviti’s comprehensive, flexible Payment Policy Management solution.

Read our Savings Spotlight and learn how the plan experienced:

• Increased prepay savings by avoiding improper claims payment
• Improved accuracy of appropriate provider payments
• Reduced provider abrasion