How to shorten time to payment integrity results

In recent times, well being plans have made important progress in shifting their cost integrity methods from postpayment correction and restoration to catching inappropriate claims earlier than cost happens. However as healthcare prices proceed to rise and the calls for for price financial savings enhance, cost integrity packages have grow to be more and more layered, nuanced, and sophisticated.

Now not is the cost timeline merely regarded as “earlier than cost” or “after cost”—as a substitute, it’s extra of a related declare continuum, the place every declare have to be processed on the proper intervention level to ship the best worth and the bottom abrasion.

Finally, a sturdy cost integrity program rests on three core pillars:

  • Figuring out accountability: This implies seeing every member inside their very own context and paying claims precisely throughout the member’s journey—with no member abrasion.
  • Guaranteeing accuracy: This implies correcting inappropriate declare coding whereas validating different suspect claims towards medical information, contract phrases, and different knowledge.
  • Detecting patterns: This implies deploying superior analytics and seasoned experience to search for patterns of fraud, waste, or abuse that may escape detection inside a claim-by-claim overview.

I invite you to observe our new video above explaining Cotiviti’s strategy to serving to you meet these three crucial objectives. You’ll learn the way we’ve been in a position to ship greater than $7 billion per 12 months to our purchasers in cost integrity financial savings—with as a lot as 80% of that financial savings occurring earlier than cost.

For extra particulars and examples of the real-world financial savings we ship to our well being plan purchasers daily, see our Fee Accuracy options overview.

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