SALT LAKE CITY--(BUSINESS WIRE)--Cotiviti, a leader in data-driven healthcare solutions, is launching 360 Pattern Review, a powerful, fully managed service that combines prepay fraud, waste, and abuse (FWA) prevention with postpay review for true FWA prevention and management across the entire claim payment cycle. Cotiviti will introduce 360 Pattern Review at the 2024 National Health Care Anti-Fraud Association (NHCAA) Annual Training Conference in New Orleans, Louisiana, taking place November 19-22, 2024.
"Fraud, waste, and abuse remain a major challenge to healthcare payment integrity, costing payers and the entire healthcare system billions of dollars each year. As these schemes continue to persist and evolve, it’s critical for plans to adopt artificial intelligence and other advanced technologies that can identify and mitigate FWA while preventing further losses,” said Matthew Hawley, executive vice president of payment integrity operations at Cotiviti. "As health plans see their medical loss ratios rise amid increased costs and utilization, 360 Pattern Review represents the next phase of Cotiviti's commitment to reducing inappropriate healthcare spending while enabling plans to protect their members’ valuable benefits."
360 Pattern Review combines the power of Cotiviti’s proven prepay Claim Pattern Review solution and the brand-new postpay FWA Pattern Review. Claim Pattern Review analyzes prepay claims and other data points to identify suspicious patterns and prevent inappropriate claims from being paid while still meeting prompt-pay requirements. FWA Pattern Review finds aberrance in paid claim data and delivers high-quality leads vetted by Cotiviti’s team of credentialed FWA experts to drive efficient postpay investigations and more recoveries.
Through specialized expertise and a unique data and analytics ecosystem, Cotiviti has supported healthcare payers with FWA prevention and management for more than 25 years, identifying approximately $15 billion in suspect claims across FWA clients in 2023.
“Amid challenges like overwhelmed or insufficient staff, disparate record systems, and incomplete data sets, health plans are looking for new fraud tools they can deploy without disrupting their existing FWA programs,” said Erin Rutzler, vice president of fraud, waste, and abuse at Cotiviti. “360 Pattern Review is the result of Cotiviti’s continued commitment to innovation to help our payer clients perform at peak efficiency and reduce the impact of FWA on their organizations, members, and the industry as a whole.”
Backed by more than 70 credentialed Cotiviti investigative and clinical analysts, 360 Pattern Review utilizes advanced provider scoring models, including artificial intelligence and expert-driven rules. The solution is deployed via Cotiviti’s industry-leading managed service model, helping plans increase the productivity of their special investigations units (SIU) without displacing existing systems.
Cotiviti, a platinum sponsor of the NHCAA Annual Training Conference, will be discussing 360 Pattern Review during a “fraudside chat” on November 20 at 5:15 pm CT, as well as demonstrating the solution’s new postpay capabilities at booth #415. Cotiviti experts will also share new insights and best practices into FWA for dental payers during a presentation on November 20 at 11:30 am CT. For more information, visit the Cotiviti website.
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, and consumer engagement 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.
