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Prioritizing prepay integrity strengthens mid-sized health plan's competitive position

Preventing improper claim payments not only helps reduce wasteful out-of-pocket costs for members and  provider abrasion, it can also help a health plan remain competitive.

That's why one mid-sized health plan with just under 500,000 members views success in prepay editing as a prerequisite for competing in the marketplace among its regional peers.

A Cotiviti Payment Policy Management client since 2011, this payer has built and maintained a comprehensive library of policy edits and is utilizing Coding Validation to tackle more clinically complex codes. Due to the mature nature of the policies in place and commitment from leadership to remain competitive, the plan is experiencing a high annual net savings percentage across its Medicare Advantage and commercial lines of business. The client is also working with Cotiviti for its administrative services only (ASO) line of business to increase overall payment integrity.

Key results*

>3.5%

Annual medical cost savings from reduced improper payments

>$242

PMPY reduction in improper payments for Medicare Advantage business

>$134

PMPY reduction in improper payments for commercial business

Key benefits

  • Increased prepay savings by avoiding improper claims payment
  • Improved competitive position in marketplace
  • Improved accuracy of provider payments
  • Reduced provider abrasion
  • Accelerated time to value

Key Cotiviti differentiators

  • Highest incremental savings value in market
  • Designated clinical consultant team
  • Integrated prepay automated editing and clinical coding review 

Perform beyond expectations with Cotiviti's payment integrity solutions

Read our brochure to learn how Cotiviti partners with health plans of all types and sizes to ensure claim accuracy by efficiently correcting inappropriate claim coding and validating suspect claims against medical records, contract terms, and other critical data. Ready for the next step? Set up an exploratory call with our team and start the conversation with Cotiviti.

Read the brochure

*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.