When deploying cost integrity options, Health plans look to maximise the effectivity of their declare cost operations whereas stopping inappropriate spending, together with fraud, waste, and abuse (FWA). This requires not solely superior analytics, sample recognition, and machine studying, however the backing of scientific and coding experience to assist make sure the defensibility of edits and cost choices.
That’s why one Medicare Benefit (MA) plan approached Cotiviti with the aim of leveraging built-in prepay integrity options to stop cost of inappropriate claims by means of a number of avenues. After implementing Cotiviti’s Payment Policy Management and Coding Validation options for automated second go declare enhancing and knowledgeable evaluate of complicated claims, the plan additionally turned on Cotiviti’s Claim Pattern Review answer to leverage the ability of superior fraud, waste, and abuse (FWA) analytics, sample recognition, and machine studying.
Learn our new case research and find out how the plan has prevented greater than $1 million in inappropriate funds in lower than one yr, bettering its cost integrity and defending members’ advantages by means of:
- Ease of implementation
- Automated prepay evaluate
- Excessive acceptance fee
- Concentrate on a high-volume suppliers
Our case research additionally particulars one particular investigation associated to extreme distant monitoring, medical testing, and allergy testing.
With the appropriate Technology in place—and the appropriate experience guiding that Technology—payers of all sizes can obtain success in defending their enterprise and their members from FWA. Learn the case research and find out how.