Payment Policy Insights

Cotiviti’s insights series for Payment Policy Management (PPM) and Coding Validation (CV) clients dives deep into claim, utilization, and other trends built from analysis of payment data from 55+ payers covering >170M members. These valuable insights will help you plan for and optimize the value of your payment integrity program.

The shift to outpatient care

As procedures that were once strictly performed in hospitals move to outpatient facilities, patients and providers alike are witnessing a shift that promises both opportunity and challenges.

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Policy on a Page%%Read our resources to unlock value from Payment Policy Management
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Optimizing payment integrity for emergency department evaluation and management claims

Read as we explore three key trends shaping emergency department E/M claims and examine their impact on payers and payment integrity programs.

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Unparalleled analytics inform key payment integrity decisions for large payer

Discover how cross-payer analytics drove payment integrity success for one of Cotiviti's health plan clients.

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Medical drug wastage and its impact on payment integrity

Understand the impact of drug wastage and how to improve payment integrity on claims billed with JW/JZ modifiers.

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Claim modifiers: Key trends and the value of prepay review

Discover insights and trends to capture more value from improperly coded modifiers.

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Four surgical payment integrity trends to watch in 2024

Read as we delve into four key trends surrounding surgical spend and utilization, highlighting the implications for payers and payment integrity programs.

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Four medical drug payment integrity trends to track in 2024

Learn about spending trends in specialty drugs that impact your payment integrity program.

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Five E/M payment integrity trends to watch

Stay aware of the latest challenges in E/M claims for Cotiviti clients.

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Finding new opportunities to improve payment integrity with inpatient claim review

Learn how to reduce the burden of research and recovery for inpatient claims with a tailored pre and postpay approach.

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Discover the impact of prospective DRG validation

Learn how Clinical Chart Validation enabled one plan to streamline and optimize DRG review while improving quality and the provider experience.

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Data Mining for pharmacy payment errors yields high savings

See how Cotiviti’s Data Mining pharmacy solution uncovered millions in inaccurate payments for two health plans using predictive analytics and specialist validation.

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The "smart prepay" approach to payment integrity

Learn how a managed service model addresses the five critical dimensions of payment integrity versus a software-only approach.

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Payment Policy Management solution

Avoid payment errors before claims get paid

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Coding Validation solution

Further reduce claim spend after claim editing programs

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