Overview
When implementing a payment integrity program, all health plans seek to make their claim payment operations run as smoothly as possible while minimizing inappropriate spend. That’s why one Medicare Advantage (MA) plan approached Cotiviti with the goal of leveraging integrated prepay integrity solutions to prevent payment of inappropriate claims through multiple avenues.
After implementing Cotiviti’s Payment Policy Management and Coding Validation solutions for automated second pass claim editing and expert review of complex claims, the plan also turned on Cotiviti’s Claim Pattern Review solution to leverage the power of advanced fraud, waste, and abuse (FWA) analytics, pattern recognition, and machine learning.