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Large Medicaid payer protects taxpayer dollars, financial integrity with Payment Accuracy prepay review solutions

Sponsored White Paper

In 2013, the largest state Medicaid payer partnered with Cotiviti, using Payment Policy Management for prepay edits and postpay DRG reviews.

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Published on Oct 2, 2024

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Disclaimer

This white paper represents the views of the author, not America鈥檚 Health Insurance Plans (AHIP). The publication, distribution or posting of this white paper by 熊猫视频does not constitute a guaranty of any product or service by AHIP.

Overview

Serving low-income members who often face challenges related to health equity and social determinants of health, Medicaid plans face some of the greatest difficulties in healthcare. Not only do they typically operate on thin margins, they also have an obligation to protect the funding they receive from taxpayers by staying vigilant against inappropriate expenditures. With the latest reported Medicaid improper payment rate reaching 8.58% according to the Centers for Medicare & Medicaid Services (CMS), Medicaid plans are also particularly vulnerable to inappropriate claims submitted by bad actors looking to exploit their members and their payment policies.