SALT LAKE CITY--(BUSINESS WIRE)--Cotiviti, a leader in data-driven healthcare solutions, is expanding its end-to-end Coordination of Benefits (COB) Validation solution by adding prospective COB validation capabilities. This comprehensive offering allows health plans to reduce overpayments by reviewing claims and determining payment responsibility after adjudication but before payment, making it the only full-service, “pause-and-pay” COB offering in the market.
“In coordinating member benefits, paying claims accurately while avoiding provider and member abrasion has become even more important following the end of the COVID-19 Public Health Emergency, which will result in benefit changes for millions of members moving from Medicaid to other payers,” said Naomi Murphy, senior vice president, coordination of benefits and data mining for Cotiviti. “Other market solutions only look at entitlement data, which is often incomplete, inaccurate, or outdated. As part of Cotiviti’s ongoing commitment to advancing claims payment accuracy, this prospective solution will further empower health plans to prevent inappropriate claim payments and will enhance the COB process for all stakeholders, including members and providers.”
The new prepay solution draws on advanced analytics to identify claims that require a comprehensive COB review before rendering a payment decision. By catching inappropriate claims before they are paid, this approach improves provider and member satisfaction by reducing the need to recover overpayments from providers and minimizing contact with health plan members.
Using COB Validation, one large health plan client reduced inappropriate claim spend by $40 million in 2022, including an estimated $11 million in prepay errors avoided. In 2023, the plan is projected to avoid more than $60 million in payment errors from COB Validation, with prepay savings comprising more than a third of that total. Combining advanced analytics with evolved business rules and COB expertise enables the solution to deliver a high degree of accuracy, typically with more than 99% of claims flagged ultimately enabling the client to avoid inappropriate payments.
Cotiviti’s end-to-end COB Validation solution supports both prospective and retrospective claim review, granting plans a holistic view of each member within their own context. The complete COB suite goes beyond entitlement-data-only products, tapping the company’s unmatched dataset and rich expertise to seamlessly link members across payers. With more than 20 years of COB experience and partnership with five of the six largest national payers, Cotiviti is continuing to deliver innovation in prepay interventions and helping plans achieve better cost efficiencies, member experiences, and outcomes with its end-to-end suite of integrated Payment Accuracy solutions.
About Cotiviti
Cotiviti enables healthcare organizations to deliver better care at lower cost through advanced technology and data analytics, helping to ensure the quality and sustainability of how healthcare is delivered in the United States. Cotiviti’s solutions are a critical foundation for healthcare payers in their mission to lower healthcare costs and improve quality through higher performing payment accuracy, quality improvement, risk adjustment, consumer engagement, and network performance management programs. The company also supports the retail industry with data management and recovery audit services that improve business outcomes. For more information, visit www.cotiviti.com.
