Defending monetary integrity with prepay overview options

Health plans have an obligation to guard their funding from inappropriate expenditures, whether or not that funding comes from member premiums or taxpayer {dollars}. However payers of all sizes could be weak to vital quantities of declare errors, waste, and abuse yearly.

This problem is especially vital for Medicaid plans, which serve low-income members who typically face challenges associated to Health fairness and social determinants of Health. With the most recent reported Medicaid improper cost fee exceeding 8.5% in keeping with the Facilities for Medicare & Medicaid Providers (CMS), these plans should defend their already-thin margins from inappropriately coded claims—on prime of unhealthy actors trying to exploit their members and their cost insurance policies.

That’s why one Cotiviti shopper, a big Medicaid payer, companions with Cotiviti for each second-pass prepay declare enhancing and prepay overview of complicated coding errors—with greater than 80% of Cotiviti’s general financial savings delivered earlier than claims are paid.

As Health plans’ medical loss ratios proceed to rise and your complete healthcare system feels the crunch of inflation and different pressures, learn the way this pragmatic strategy to decreasing inappropriate declare funds delivers tangible advantages to Health plans—enabling them to guard their integrity by serving to guarantee their monetary assets are spent correctly.