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Medicare Advantage plan reduces inappropriate payments by millions with Claim Pattern Review

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A Medicare Advantage plan partnered with Cotiviti to streamline claims and reduce improper payments using integrated prepay integrity solutions.

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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

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鈥檚 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鈥檚 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鈥檚 Claim Pattern Review solution to leverage the power of advanced fraud, waste, and abuse (FWA) analytics, pattern recognition, and machine learning.